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DISEASES 
.... 

TEMPLE S. HOYNE, A. M., M. D. 



Professor of Theory and Practice, and Clinical Professor of 

Skin and Venereal Diseases in Hahnemann Medical 

College and Hospital of Chicago. 




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HALSEY BROTHERS, 

CHICAGO JL3STX) X>ETI^OIT 

CULVER, PAGE, HOYNE * CO., PRINTERS. 







Entered, according to Act of Congress, in the year 1883, by 

T. S. Hoyne, A. M., M. D., 

In the office of the Librarian of Congress. 



PREFACE. 



At the urgent request of members of the College, classes of 1881 
and '82, and 1882 and '83, I have consented to the publication of the 
following pages, which were prepared for my lectures on venereal 
diseases. As the time devoted to this branch of study in the Col- 
lege curriculum is necessarily short, the lectures were arranged with 
the idea of presenting the whole subject in as brief a manner as 
possible ; hence, long discussions on many disputed points are en- 
tirely omitted. The student and practitioner will, I hope, find that 
while I have condensed as much as possible all that is said on the 
subject, that I have not thereby failed to give a clear exposition of 
the different affections mentioned. 

It may be proper to state that I still hold the opinion that there 
is but one kind of syphilitic virus, producing in the one case a hard 
chancre, and in the other a soft chancre, and that both these sores 
may be followed by secondary symptoms. 

At the request of my publishers, who claim that a slight resume 
of the remedies suitable for urinary disorders is greatly needed, I 
have added the last few pages. 

T. S. Hoyne. 

1634, Wabash Avenue, Chicago. 



VENEREAL MAS 



VENEREAL DISEASES. 



Venereal disease is a term used to denote affections arising prima- 
rily from sexual intercourse. The word venereal comes from the 
Latin word veneris, meaning that which relates to pleasure. In a 
more restricted sense, however, the word is considered synonymous 
with syphilis or syphilitic. Some writers have proposed that those 
diseases should be called venereal which are produced by excesses in 
venery, and that the term syphilitic should be applied to those which 
are the result of impure connection. The custom is to include 
under the head of venereal all affections arising from sexual inter- 
course, hence the terms venereal and syphilitic are generally used as 
synonyms. 

The venereal diseases are two, viz., gonorrhoea and syphilis. The 
etymology of syphilis is unknown. It may be derived from 8/y.q, a 
hog, and <pdeo, I love ; or from <5//v, with, and <pueo, I love ; or from 
ScnaXog, a reproach, etc. It was supposed by Hunter and other 
eminent waiters that all specific diseases arising from sexual inter- 
course were due to the same poison which affected different individ- 
uals in various ways. These views were, however, incorrect 

Syphilis, in brief, is a specific, infectious disease, acquired only by 
inheritance, or due in the majority of cases to sexual intercourse, and 
is communicable by coition, or by the contact of parts that are 
abraded, or are only lined with a thin epidermis, as the lips, nipples, 
etc., and is characterized by periods of eruption and periods of repose 
of variable duration. In fact, the disease may at any time be com- 
municated by the contact of a sound with the secretion from a dis- 
eased surface. It is essentially a contagious, virulent disease, of 
quite regular course, susceptible of cure, but liable to become an 
heir-loom in the family, and be transmitted to the offspring. It 
manifests itself in a variety of ways, not always as a special affection, 
but impresses a peculiar form on all inflammatory diseases which it 
induces. The earlier symptoms are, as a rule, superficial, the later 
ones visceral. 



10 ORIGIN OF SYPHILIS. 

The definition just given is incomplete, but is the best that can 
be given without a thorough classification of all its phases. As a 
rule, it attacks a person but once, although there are numerous 
exceptions on record. A subsequent attack is usually much lighter. 
Syphilis always makes its first appearance in the form of a chancre, 
followed sooner or later by a bubo, and perhaps by secondary or 
so-called constitutional symptoms. 

The origin of syphilis is enveloped in great uncertainty. It was 
formerly claimed that the disease was introduced into Europe from 
America by Columbus at the end of the fifteenth century, and many 
hold this opinion at the present day, notwithstanding the fact, that a 
Chinese writer who lived 2637 years before Christ described two 
kinds of chancres, and gave a full description of the secondary stage. 
In ancient Hindoo, Arabic, Greek and Latin literature similar 
descriptions are found. While the Bible does not anywhere give an 
accurate description of syphilis, we find numerous references to it, 
e. g., King David complained of sharp pains in his bones. We are 
satisfied that the disease is not a modern one, and certainly do not as 
Americans wish to claim the honor (?) of inventors. It is more 
than probable that in ancient times leprosy and syphilis were con- 
founded, as the former was said to have frequently followed sexual 
intercourse, and hence in the Bible and elsewhere many symptoms 
occasioned by the latter were attributed to the former affection. 

The progress of syphilis is extremely variable, as well as its dura- 
tion, being unlimited if not treated skillfully and continuously. But 
of this we shall speak later. 

The only proper way to study the disease is at the bedside, or face 
to face, where every little symptom that goes to make up its history 
can be carefully weighed and compared. No two cases will be found 
exactly alike in every particular, but all will present a striking simi- 
larity. You will find a great many obstacles in the road, even when 
the patient is desirous of a cure. The diagnosis is not always clear, 
especially when complicated with other affections ; the chancre may 
not be in sight, but concealed within the urethra ; congenital phymo- 
sis may obstruct your vision ; the patient may be ignorant and unin- 
tentionally deceive you, denying the existence of a primary sore 
which was so insignificant that he thought it of no consequence, or 
considered it merely an abrasion, or he may shamefully lie to you, 
thus endeavoring to shield himself from all culpability. In the see- 



STUDY OF SYPHILIS. 11 

ondary stage it is not uncommon for patients to deny having had a 
chancre or primary sore ; in chancre about the mouth or secondary 
ulcerations, when the origin is due to contact of the mouth with the 
genital organs, seldom is the truth obtained from the patient ; neither 
is it when sodomy has been committed. But by carefully question- 
ing and cross-examining the physician will finally arrive at the true 
state of the case. 

The disease generally commences in the genital organs, as sexual 
intercourse is by far the most common cause, and shows itself in the form 
of a sore of a specific character, and if not immediately arrested, which 
is not always possible, it invades the lymphatic ganglions of the groin, 
next the skin and mucous membranes, and lastly, the bones, cartilages 
and fibrous tissues. It should not be inferred from this that all of 
these parts are affected at one and the same time, for it is Dot so 
(with few exceptions) ; the essential poison upon which the infec- 
tion depends lies dormant, so to speak, for a certain length of time, 
say from four to six weeks, in the tissues in which it has been 
deposited, limiting its poisonous influences strictly to the genital 
organs, and sometimes to the lymphatic ganglions of the groin. If 
the disease is not arrested in this the first stage, in about a month 
or six weeks, the skin and mucous membranes are affected, as we 
stated a moment ago, and if still unarrested, in from five to 
eighteen months, we find the bones, cartilages and fibrous tissues dis- 
eased . 

For convenience of description, syphilis, the progress of which 
is regular, is divided into three stages, viz. : primary, secondary and 
tertiary. There is also another division called the period of incu- 
bation ; for example, when the syphilitic poison has been innoculated, 
or been placed in contact with a surface capable of absorption, it 
gives no evidence of its presence for several days, and then shows 
itself by induration at the point of innoculation. A similar period of 
incubation is common in all contagious diseases which involve the 
purity of the blood. 

By primary syphilis we understand that period during which the 
poison is limited in its action to the genital organs, or to any healthy 
surface to which it has been brought in contact, manifesting itself 
in the form of sores and ulcers, called chancres, no matter where 
they occur. Lymphangitis and adenitis may also be present. By 
secondary, that the mucous and cutaneous surfaces are affected, only, 



12 THE THREE STAGES. 



however, after primary has been known to exist ; and by tertiary, 
that the bones, cartilages, fibrous tissues and internal organs are im- 
plicated. Some authors have divided the disease according to time, 
everything appearing under six months being considered secondary, 
and every symptom after that time tertiary. 

The three stages are usually separated by pauses of greater or 
less duration, but not invariably, for occasionally patients exhibit 
signs of all three simultaneously, the stages following one another in 
very rapid succession. If syphilis is not arrested in the primary 
stage by proper treatment, which may destroy the syphilitic diathesis, 
the symptoms always follow in the same order, never skipping any 
stage, as was at one time supposed possible by Ricord. 

It is definitely settled that syphilis never arises spontaneously, 
but is always the result of innoculation with a peculiar poison known 
as the poison of syphilis or chancre. It never exists without 
chancre, or a lesion of some sort at the point of entry of the poison, 
except when hereditary. This primary sore may exist in some un- 
usual situation, where its presence remains undetected and unsus- 
pected as the anus, buccal cavity, etc. Of the precise nature of this 
poison we are wofully ignorant ; we only know it by its effects on the 
system. It should be stated, however, that Klebsand others suppose 
that they have discovered what it is, and are now at work trying to 
demonstrate that it is due to a spore in the blood. The poison, 
when brought in contact with a healthy surface, invariably gives 
rise to a disease similar to itself, the resulting sore or ulcer yielding 
a virus in every respect identical with that which produced it. The 
virus reproduces and multiplies itself by a process of zymosis or 
fermentation ; hence syphilis is similar to other zymotic diseases — 
affections produced by a morbific principle acting on the organism 
like a ferment. The gravity of the symptoms is not in proportion 
to the amount of virus absorbed, for the smallest inconceivable atom, 
perhaps the thirtieth potency, when brought in contact with an 
appropriate surface, is sufficient to fully develop a disease, which, if 
unarrested, may give rise to fearful results both local and constitu- 
tional, leaving a peculiar and distinctive impression upon all the 
organs and tissues affected, and often affecting the solids and fluids so 
that the disease is transmissible from parent to child. 

The pus from a chancre or other sore, containing the syphilitic 
virus, even when subjected to the most rigorous analysis, does not 



CHEMICAL AND OTHER CHARACTERS. 



exhibit in its chemical, physical or microscopical characters, any 
differences from other pus, and may possess all the characteristics of 
what is termed healthy pus. (At one time it was claimed that a 
vegetable parasite had been discovered in the secretion.) Neither 
does the blood, subjected to the same rigorous test, present anything 
which may be termed diagnostic (unless Klebs' reported discoveries 
are true), although we know that if it is innoculated it will produce 
syphilis. The syphilitic virus may be preserved in a well corked 
vial, in a moderate temperature, for a number of weeks, without losing 
its poisonous character, or infecting properties. Cases are on record 
in which it has been thus preserved for a number of months without 
any loss of virility. Its poisonous quality can be destroyed by acids 
and other agents, or by altering its chemical constitution by excessive 
heat, and it is rendered inert by gangrene of the surface to which it 
is applied. Cold destroys the gonorrheal poison, but not the syphilitic 
virus, which may be frozen and again thawed without losing its in- 
fecting properties. 

All races, ages, temperaments and both sexes are equally liable 
to be affected by it. It is no respecter of persons ; rich and poor ae 
both alike subjected to its ravages if brought in contact with it. It 
is more severe in cold than in temperate climates, and always more 
severe in hot or cold climates in those who are not acclimated or are 
foreigners. When the affection first makes its appearance in a com- 
munity, its progress is more rapid and the cases more severe. It is 
always more severe in persons of enfeebled constitution or in those 
of a scrofulous diathesis. As regards race we should perhaps make 
one exception in modern times, and that is the Jews, who are rarel 
affected with syphilis. Out of a vast number of cases, we have seen 
but two who were afflicted. The reason of this comparative exemption 
is, we believe, due to the fact that the foreskin being gone, there 
is less chance for the retention of the virus upon the exposed parts ; 
and furthermore the penis, especially the head and anterior portion 
of the skin, becomes hardened and toughened, thus rendering the 
circumcized ones less liable to an abrasion of the parts. 

Syphilis produces its peculiar impression most readily when the 
virus is applied to a clean, ulcerated surface, an abrasion or a recent 
wound ; but innoculation frequently takes place in other ways, it 
simply being necessary that the poison should be retained or kept in 
contact with a part until its structure is brought thoroughly 



14 CARRIERS OS TEE DISEASE. 



under its influence. When the virus of chancre is applied to a 
sound external integument, which has become hardened by constant 
exposure to the air, it is generally innocuous. If, however, the syphilitic 
virus is applied to a perfectly healthy part not so hardened, several 
days usually elapse before it is absorbed or gives any evidence of its 
presence, because it has first to act as a common irritant corroding 
the surface, or it may be wiped off or otherwise destroyed before this 
occurs. It has been noticed that women, unconsciously, frequently 
give syphilis in this way without themselves being affected. For in- 
stance, they have sexual intercourse with a person affected with chan- 
cre, the pus of which may lodge in a fold of the mucous membrane 
of the vagina, and then, without washing, they repeat the act with 
another comer who takes up this deposited virus. Thus a woman is 
often merely a carrier of the disease. However, they are not the 
only ones who thus carry it, for there is a case on record in which a 
man having seen his mistress the early part of the night, and his wife 
the latter part, carried on the prepuce the syphilitic virus from the 
former to the latter. Bicord says : " Venereal diseases would be less 
frequent if women were more cleanly," and we may add to this that 
they would be still less frequent if men were less intemperate 

The syphilitic virus is communicated in a number of ways, not, as 
was believed in the fifteenth century, by the breath of the invalid, by 
means of the air which surrounded him, by the perspiration, through 
the medium of holy water (which is not impossible), and in numer- 
ous other ways ; but (1) by sexual intercouse, which is by far the 
most common ; (2) by unnatural connection, giving rise to chancre of 
the anus and perineum ; (3) by sucking the genital organs, as in cir- 
cumcision, or as a crime, giving rise to chancres in the mouth, or upon 
the tongue or cheeks ; (4) by vaccination (this is denied by many, 
but a sufficient number of cases are recorded to establish the truth of 
this method of communication) ; (5) by towels, spoons, forks, pipes, 
tumblers, children's toys, pens, pencils, bank-notes, cigars and other 
articles ; (6) by chamber vessels and water-closets ; (7) by surgical 
instruments, sponges and dressings ; (8) by kissing ; (9) by nursing 
syphilitic children ; (10) by the fingers of the affected individual. 
An affected individual may by means of the fingers innoculate his 
eyes, lips, nose or any abraded, raw or open surface upon any portion 
of his body. Physicians occasionally innoculate themselves in this 
way from their fingers, after examining women during labor, or those 



PRIMARY SYPHILIS. 15> 



affected with chancre of the vulva, vagina or uterus. There must be 
an abraded surface, however. We recall to mind a case where a man 
was bitten on the nose in a street fight by a syphilitic person, and a 
chancre occurred at the site of the injury in about a week. Dentists 
sometimes contract the disease from examining patients with mucous 
patches in the mouth. 

The length of time the syphilitic virus remains in contact with a 
part before it begins to act is still an open question, as in some cases 
a chancre is found within twenty-four hours, and, in other cases, not 
for a number of days or even weeks, one instance being reported by 
Fournier where the incubation lasted seventy-five days. The aver- 
age time is from five to ten days. It is undoubtedly true that the 
virus acts immediately, but with greater or less rapidity according to 
the susceptibility of the patient ; the greatest rapidity usually being 
observed in persons of a scrofulous diathesis. 

Primary syphilis is usually considered strictly a local disease, con- 
sisting of a chancre (something which eats) or ulcer of the genital 
organs, with or without a bubo, or swelling of the lymphatic gangli- 
ons of the groin, sometimes ending in suppuration and other bad 
effects ; we, however, consider it a constitutional disease from the 
start, and look upon the chancre simply as the local manifestation of 
the disorder. If we take a small quantity of virus and insert it with 
a lancet just below the epidermis, at the end of the first day we shall 
see a little red speck, such as might follow any puncture of the skin. 
The part is slightly inflammed, hot, red and itchy. The following 
day a minute papule will be noticed, which changes into a vesicle 
about the fourth day, and is surrounded by an areola of a deep red 
hue. The next change is to that of a pustule on the fifth day, the 
pustule resembling that seen in small-pox, with the umbilicated ap- 
pearance, and the distinctive areola. Now the structures about the 
pustule become hard from the deposit of plastic matter, and when 
pressed between the fingers feel like a mass of fibro-cartilage. On 
the sixth day, at the time the induration just described occurs, the sore 
becomes possessed of the requisite properties for supplying infecting 
matter. The pustule now turns dark, its contents solidify, and a small, 
round but thick scab forms, having the shape of a truncated cone. 
If we remove the scab, we shall find a circular and depressed ulcer, 
which looks as if it had been scooped out with a punch. The edges 
are steep and slightly ragged, the base firm and hard, and its bottom 
covered with a layer of grayish lymph. The discharge is thin, sani- 



16 SITE OF THE SORE. 



ous or ichorous. This ulcer has received various names, viz., the 
infecting chancre, the indurated chancre, the Hunterian chancre. 

The main points to be remembered are that the disease com- 
mences with a papule, becomes a vesicle, then a pustule followed by 
an excavated ulcer, with a hardened base, covered with pus which is 
capable of contaminating the fluids or solids of the body. 

A chancre, may appear upon any part of the body, although it 
generally occurs on the head of the penis, the fraenum, the prepuce, 
the fourchette, the clitoris, the vulva, vagina or uterus, these parts 
being the ones most exposed to the contagion. Sometimes, but not 
very often, the urethra is attacked; and, in other cases, chancres are 
met with at the margin of the meatus. In fact, any portion of the 
genital organs or other parts of the body may be the site of the sore, 
from the presence of an abrasion or scratch of a pin, although it most 
frequently appears on the corona or fraenum, because the construction 
of these parts is such that the poison is more readily retained until 
absorbed. In the female they are more frequent on the vulva, al- 
though the perineum is occasionally attacked. From the scratching 
of pins and buttons the abdomen is sometimes the seat of the disease. 

There are no general or local symptoms that usher in the disease, 
with the exception of some heat, itching and increased sensibility of 
the part which has become innoculated. If the virus of a chancre is 
deposited on an abraded surface, it should be remembered that the 
primary sore commences as an ulcer, and does not necessarily pass 
through the stages described a moment ago, and the progress of the 
disease is more rapid than if otherwise absorbed. When the virus 
has been absorbed into the orifice of a mucous follicle, the disease 
commences with a boil or abscess. A follicular chancre (i. e., one 
commencing in a follicle and appearing like an acne pustule) is more 
frequent in women than in men, and is usually observed on the labia 
majora as a small rounded ulceration, with a hair passing through it, 
and is depressed in the center with slightly elevated edges. The dis- 
charge is purulent and copious. 

The patient does not usually present himself during the vesicular 
or pustular stage of incipient chancre, and the physician only sees 
him when the sore possesses all the characters of a well defined chancre, 
and thus we are unable to say how long it has existed. The early 
commencement of a chancre is so insidious, that it often passes un- 
noticed, and it is only when an ulcer exists that remedial measures 
are sought, or it may be so insignificant that the patient thinks 



HARD AND SOFT CHANCRE. 17 

it of no importance, and it is only by accident that it is seen, if at 
all. Surgeons have divided chancre into two varieties, the indurated 
or hard (also called the infecting chancre and the true chancre), and 
the non-indurated or soft (sometimes called chancroid or chancrelle), 
both dependent on the same poison, but modified or aggravated ac- 
cording to some unknown, or local or constitutional cause. There 
is always a period of incubation, but it is extremely variable in 
both — one day being the shortest time and seventy-two days the 
longest. The average time is from five to ten days. Why the 
syphilitic virus should produce an indurated chancre in one case and 
a soft in another is not known, but it is supposed that this virus acts 
as other poisons, with very different effects on different constitutions. 
Bumstead states that a " soft chancre transmits either a chancroid or 
a syphilitic (hard) chancre, according to its origin. If it was derived 
from a chancroid, its innoculation will occasion a chancroid ; if it was 
produced by the syphilitic virus,' it will give rise to the initial lesion 
of syphilis." But we should have stated that Ricord, Bumstead 
and others maintain that there are two kinds of syphilitic poison, 
one giving rise to the true (hard) chancre, which is followed by sec- 
ondary or tertiary symptoms, and the other giving rise to chancroids 
(soft chancre), a merely local trouble, often troublesome and per- 
sistent, but never followed by secondary or tertiary syphilis. If we 
accept the conclusion of Bumstead given above, we are always left 
in the dark as regards the prognosis, unless we can have brought 
before us the one from whom it was contracted, and perhaps five or 
six others before the last. The fact is, two persons affected from 
the same source do not necessarily have the same type of chancre, 
although they acquire the same poison, and as yet we have no ra- 
tional solution of the problem. The whole subject of primary 
syphilis is as yet improperly understood, although the so-called 
dualists explain or attempt to explain the occurrence of hard and 
soft chancres contracted from the same identical sore, on the theory 
that some chancres are mixed sores capable of communicating both 
varieties. The soft, infecting chancre, it is also claimed, is only or 
rarely found in an individual not previously syphilitic. Our own 
views are that we have but one poison and that may cause a hard or 
a soft chancre. Hard chancre is sometimes contracted from the 
virus of a soft chancre, and vice versa, but this is exceptional, as 
chancres usually reproduce themselves in kind. Soft chancre is 
really a milder form of the disease. It is true that hard chancre is 



18 



DIFFERENTIAL DIAGNOSIS. 



more often followed by constitutional symptoms, but there is plenty 
of proof that the soft chancre is also followed by the same symptoms 
in quite a number of cases. We only wish we could believe that 
the soft chancre is not followed by constitutional effects, for it is 
much more frequent than hard chancre. The cases we have pre- 
sented in the clinic of Hahnemann Hospital have shown conclusively 
that secondary syphilis is not rare after the soft variety of chancre. 

Sometimes patients are not aware of the presence of chancre at all 
until some other complaint induces them to visit a physician, and he 
then makes the discovery for them. This is particularly true in the 
case of soft chancre when it commences as an ecthymatous pustule, 
the patient not supposing the difficulty to be anything more than a 
slight boil. Should it commence, however, as an ulcer, then his sus- 
picions are immediately aroused. 

The table below gives the differential diagnosis between hard and 
soft chancre. 



HARD. 

Shape, round, oval or a fissure ; 
diameter of a 5 cent piece. 

Surface hollow, as if scooped 
out, and incrusted with a layer of 
dirty-grayish colored lymph, firm- 
ly adherent. 

Edges are hard, adherent, ele- 
vated and inclined slopingly from 
within outward. Never under- 
mined. 

Adenitis constant, multiple and 
indolent. 

Base hard like a mass of fibro- 
cartilage. Induration begins 
about the fifth day, and increases 
up to the tenth ; the amount 
varies, being greatest on the head 
of the penis and less on the pre- 
puce ; is often absent in females ; 
it lasts even after the chancre is 
cicatrized. 

Cicatrix, round, honey-combed. 



SOFT. 

Occasionally round, but not 
usually. 

Superficial, flat, uneven, covered 
with a yellowish, grayish or dirty 
deposit. Often looks as if worm- 
eaten. 

Overhanging, sloping or shelv- 
ing, ragged, painful. When the 
sore is on the head of the penis, 
it looks as if cut out with a punch. 

Not constant. 

Not hard, except when due to 
inflammation or when irritating 
applications have been used, caus- 
ing a plastic deposit. 



No special characters. 



DIFFERENTIAL DIAGNOSIS. 



ia 



Generally solitary, but not al- 
ways by any means. 



Situated upon the genitals, 
lips, nipples or fingers. 

Does not spread. 

Pain absent. 

Areola distinct. 

Progress slow. 

Discharge thin, serous sanguin- 
olent or ichorous — not very free, 
and difficult of innoculation. 

Bubo accompanies generally, 
or follows. 

Secondary and tertiary symp- 
toms are the result. 



from 



Multiple as a rule ; often as 
many as six or eight, situated at 
the free margin of the prepuce. 
May all arise at once, or be 
formed from one by fresh innoc- 
ulation. 

Anywhere. 

Spreads ; often phagedenic. 
Present, but moderate. 
Has none. 

Rapid, but gets well slowly. 
Purulent and abundant, easily 
innoculated. 

Not generally. 

Also true, but not so uniformly. 

Two or more days. 

Frequent. 



Period of incubation 
seven to twenty days. 
Complications rare. 

As regards the relative frequency of hard and soft chancre, it has 
been observed that in the lower classes the soft is much more com- 
mon, probably four to one ; while in the upper classes the indurated 
is seen in three cases out of four ; thus proving, what was stated a 
short time ago, that intemperance, bad hygienic surroundings and 
bad food were remote causes for the soft variety of chancre. 

How long does a chancre retain its specific character ? We know 
that the contagious power is at its maximum during the stationary 
period of the ulcer, and that this power gradually diminishes as 
healing commences, but the exact time at which it ceases to be conta- 
gious we do not know. Some authors believe that a chancre loses its 
infecting properties in ten days, others in two weeks, and others not 
for many months, while many maintain that it loses the infecting 
virus as soon as healthy granulations are observed. At any rate, it 
is safe to say that it may possess contagious properties until it is 
completely cicatrized. 



20 GANGRENE. 



Ricord states that one attack of hard chancre protects the indi- 
vidual against a subsequent one, but as we have already stated proof 
is wanting on this point. In fact, enough cases have already been 
reported to show that it is not true. It is not denied that the same 
individual can repeatedly experience attacks of soft chancre. Other 
varieties of chancre are mentioned by authors, such as the inflamma- 
tory, phagedenic or ulcerative, sloughing or gangrenous, diphtheritic, 
etc., etc., but there is really no necessity of such a division, as these 
are complications, strictly speaking, of hard or soft chancre, dependent 
on want of cleanliness, frequent sexual intercourse, bad treatment, 
bad sanitary surroundings, alcoholic drinks, the state of the general 
health, the season of the year, too stimulating or too sparing 
diet, etc., etc. 

The worst chancres we are called upon to treat are found iu the 
lowest of the low, half-starved, drunken wretches, who have frequent 
intercourse with persons as vile as themselves. Do not imagine from 
this, however, that we never find bad cases among the rich, sur- 
rounded by every luxury, and enjoying the best of health ; syphilis 
is no respecter of persons, and takes strange freaks at times. 

All chancres are inflammatory affections, hence it is only when 
an excessive amount of inflammation is present that we are war- 
ranted in pronouncing it an inflammatory chancre. This variety 
occurs in dirty, intemperate or aged persons or in those who are 
obliged to follow very laborious occupations. Another frequent 
cause is the strangulation produced by phymosis, congenital or acci- 
dental, and paraphymosis, which increase the flood of blood to the 
part. In this form of chancre there is considerable pain and swell- 
ing of the parts involved, accompanied by an increased discoloration, 
with more or less phlegmonous engorgement and an unhealthy aspect of 
the ulcer, which discharges a copious thin ichor. Erections are 
usually present, the prepuce oedematous, and the whole penis greatly 
enlarged. The inflammatory chancre sometimes follows the too. 
rapid administration of mercury or its compounds. 

Sometimes gangrene sets in, usually in consequence of the confine- 
ment of pus under an elongated prepuce, and is always a serious 
complication. It always follows violent inflammation ; and mental 
emotions, sexual indulgence, alcoholic drinks, want of cleanliness 
and intestinal disorders are predisposing causes. Gangrene affects 
usually the upper portion of the prepuce, the slough being limited to 



COMPLICATIONS. 21 



the tissues surrounding the ulcer, and is always accompanied by phy- 
mosis. While affecting by preference the prepuce, it occasionally 
attacks the head of the penis, or it may spread from one structure to 
the other, or may attack both simultaneously. The progress of gan- 
grene is more or less rapid, and the destruction of tissue often very 
great — in bad cases destroying the whole penis. The occurrence of 
gangrene, which occurs early in the course of the chancre, is 
announced by a blackish spot, preceded and accompanied by an 
intense burning pain and increase of the other inflammatory phe- 
nomena. When the chancre is concealed, we recognize it by the 
swelling, pain and fetid sanious discharge which is always present. 
There is increased febrile action, with an accelerated and irritable 
pulse, considerable thirst, loss of appetite, constipation and restless 
sleep. Gangrene, as we have already stated, destroys the syphilitic 
poison. 

Phagedena is a rare, but the most serious complication of chancre. 
It is very similar to hospital gangrene and occurs, but not invariably, 
in those whose constitutions have been ruined by mercury, intemper- 
ance, improper hygienic surroundings, improper and insufficient food 
and other debilitating influences. Sailors, prisoners, soldiers and in- 
habitants of tenement houses are the victims of this terrible affliction. 
The application of ointments (greasy) predisposes the patient to this 
form of chancre; so also does cold weather. Phagedena usually 
attacks the soft variety of chancre, but not invariably. When pres- 
ent, the sore extends rather slowly, but continuously, eating and 
destroying the parts, both laterally and inferiorly. Sometimes its 
ravages are very rapid, destroying in a few hours a vast amount of 
tissue. Its favorite sites are the gutter upon the head of the penis 
and the under surface of the penis at the side of the fraenum.' If 
by chance the dorsal artery of the penis is in its way and becomes 
corroded, a serious, if not fatal, hemorrhage takes place. Occasion- 
ionally phagedena occurs as an endemic in crowded hospitals, when the 
atmosphere is unhealthy and foul. Its duration is always prolonged 
and is difficult of arrest. It does not destroy the danger of consti- 
tutional infection, as gangrene does, provided that we accept the 
theory that primary syphilis is merely a local disease. 

An interesting form of chancre is the serpiginous or erosive, the 
sore extending about, like a snake, in different directions, usually in 
circles or half circles and seemingly without limit. Another pecul- 



22 SERPIGINOUS AND DIPHTHERITIC CHANCRE. 

iarity is that wnile one part of the ulcer is perhaps cicatrizing, 
another portion is steadily advancing in an opposite direction. Some- 
times the sore seems to be arrested and nearly well when rapid ulcer- 
ation again sets in. We find this variety, as a rule, in scrofulous 
persons, such as are predisposed to phthisis, scurvy and chronic erup- 
tions; such as have thin, delicate skins, which ulcerate from the 
slightest injury. This ulcer, though usually of a superficial char- 
acter, sometimes penetrates deeply into the tissues, and, as it is 
essentially of a chronic nature, destroys a great amount of tissue 
before it can be checked. Its surface is uneven, covered with a dirty, 
grayish lymph, with more or less ichorous fluid, and its edges are 
thin, livid, ragged, steep and somewhat everted ; often are so exten- 
sively undermined that they can be turned back like a flap. It 
sometimes extends under the skin of the penis as far as the abdo- 
men, leaving as it heals an indelible white scar. 

The French authors describe a diphtheritic chancre to be one 
which is very sensitive to the touch, accompanied by a sharp, con- 
tinuous pain, and which is covered with a thick layer of glistening 
gray or yellowish white lymph, resembling leather. It is very rare, 
occurs only in persons of debilitated constitution, appears at any 
period of the ulceration and always denotes an irritable and inflamed 
condition of the parts. Nature is unable to convert this lymph into 
healthy granulations, and hence it is thrown off as of no further use. 
The edges of the ulcer bleed on the slightest touch, and sometimes 
very profusely, almost amounting to a hemorrhage. Any attempt 
to detach this diphtheritic layer is also attended by hemorrhage. 

The diagnosis of chancre is in the majority of cases comparatively 
easy, when we consider the period of incubation and the condition of 
the base, and it is only occasionally that one is in doubt whether the 
ulcer on the genitals or elsewhere is or is not a chancre ; but the 
physician may require considerable time to determine whether he 
has the hard or soft variety to deal with. The table given a few 
months ago will aid greatly if the sore is regular and uncomplicated. 
The physician should be very cautious about pronouncing a positive 
opinion concerning the ulcer upon the genitals, following a suspicious 
connection. Let him take time enough to fully observe its true 
character, and if necessary examine the person from whom it was 
derived. If all other means of diagnosis fail, a small portion of the 
suspected matter may be innoculated, which, if specific, will soon 



DIAGNOSIS AND PROGNOSIS. 23 

show itself. Chancre is liable to be confounded with simple abra- 
sions, eczema, herpes or balanitis. Herpes is an eruption of groups 
of vesicles, preceded by fever and slight digestive trouble. The 
vesicles are of a whitish color, about the size of a pin's head and 
are seated on a red base, and attended by considerable itching, heat 
and pain. They occur on the head of the penis and prepuce a day 
or two after exposure. When they occur on the lips, the diagnosis 
is more difficult, and more time is required. Cleanliness and time 
will soon render a positive diagnosis possible. Innoculation will pro- 
duce an ecthymatous pustule, if syphilitic. In eczema, we find the 
vesicles still smaller, and greater irritation ; the surface constantly 
discharges a thin, watery fluid, which stains and stiffens linen. The 
parts are swollen, red, hot and itchy. The prepuce is the site of the 
eruption. In balanitis, the discharge is profuse, thick and muco- 
purulent, and the inflammation widely diffused. The history of the 
case often affords the means of diagnosis. Young or married 
men sometimes have abrasions accidentally produced by excessive 
friction during coitus, by the action of irritating secretions, or the 
entanglement of a hair, and seek the physician for a diagnosis. In 
such cases time must be taken in order to determine whether the 
sore is of a specific nature or simple in its character. In all 
doubtful cases, carefully examine the groins, for bubo is rare in non- 
specific affections. 

As regards the prognosis, we may state, in general terms, that 
hard chancre is a mild disease, locally considered, its danger being 
due to its after effects, as shown in the secondary stage ; but it should 
be remembered that secondary symptoms do not always follow, even 
when the chancre is left to itself. If the patient is experiencing a 
second attack of hard chancre, the symptoms are very mild indeed, 
unless phagedena is present. The duration of this sore is shorter 
than that of the other variety. The soft, on the other hand, is apt 
to be a serious affection, owing to the complications usually present 
(gangrene, phymosis, phagedena, etc.) and the extensive destruction 
of tissue. Secondary symptoms follow in a certain proportion of 
cases. 

Having described chancre, it now remains to consider the treat- 
ment. The allopathic school usually employ nitrate of silver or 
some other caustic in the first instance, that is, if the chancre is 
seen before the fifth day. Some authors advise removing the dis- 



24 TREATMENT. 



eased surface with the knife, while others doubt the propriety of 
such an operation, and also affirm that it is attended with great 
danger of fresh innoculation from the diseased portions. Mercury 
and its compounds constitute the internal treatment. Berjeau very 
sensibly remarks " that the practice of destroying the chancre by 
lunar caustic is one of the most fatal practices of the present day. 
It does not, by any means, follow that because we have suppressed 
the outward manifestations of the disease we have thereby van- 
quished it. On the contrary, we have destroyed our most valuable 
guide, and one cannot possibly tell whether or when the patient 
is rid of his complaint. When we find the chancre yielding to the 
internal use of medicine, properly selected, we can be certain that 
the patient is in a fair way to recovery ; but when caustics or various 
repellants are employed, the disease becomes more intractable and 
complicated, secondary symptoms arise, or the patient is carried off 
by consumption or suffers for the remainder of his life from some 
chronic complaint, it being no uncommon thing to find persons at- 
tributing and with good reason, all the miseries of ill health they 
have undergone to syphilis badly treated in by-gone days. The 
proper remedy must be selected with reference to the form, extent 
and duration of the ulceration, the constitutional and moral dispo- 
sition being taken into consideration." 

" Cleanliness is akin to godliness," and the parts should be kept 
as clean as possible, either by the introduction of patent lint between 
the glans and the prepuce, or by frequent injections of warm, car- 
bolized water under the prepuce. When the sore is extremely pain- 
ful, a sponge soaked in warm carbolized water can be squeezed over 
the ulcer from time to time. From an experience of many years we 
must decidedly protest against the use of cosmoline or other oint- 
ments. Ulcers thus treated rarely do well. The patient should be 
kept as quiet as possible, and if gangrene or phagedena occurs, 
absolute rest should be insisted upon, as neglect of this precaution 
greatly prolongs and enhances the danger of the disease in spite of 
the treatment. Alcohol, stimulants of every kind, fat and salty food 
should be prohibited. The best diet is rice, fish, corn-starch, bread, 
fruit, and black tea or mineral water as a beverage 

Mercury, though a partial similium to chancre, is not a perfect 
one, hence we cannot always depend upon this remedy alone. 
It is indicated, provided the patient has not already taken it in 



TREATMENT. 25 



allopathic doses, when the ulcer has hard sharp and irregular edges, 
painful to the touch, the base hard covered with lardaceous matter ; 
in all recently acquired, superficial ulcers, with free secretion of thick 
pus ; spreading and deeply penetrating ulcers on the glans and pre- 
puce ; phagedenic appearance of the chancre, with a thin ichorous 
secretion ; chancres which bleed readily are very painful, and secrete 
a yellowish, white fetid pus. The above symptoms are usually cured 
by mercurius solubilis. However, it may be necessary to resort to 

Mercurius cor or mercurius precipitatus rubrum. if the above 
fails to produce any effect in four or five days, especially when the 
ichor firmly adheres to the bottom of the ulcer and cannot be re- 
moved without considerable bleeding. 

Cinnabar will be found of benefit in scrofulous patients when 
Mercury, although indicated, does not seem to benefit the patient. 
Old, neglected or badly treated cases. 

Nitric acid would naturally be considered next, as it is a most 
valuable remedy in cases which have been mercurialized ; and, in 
fact, it takes equal rank with Mercurius in the treatment of chancre. 
It is indicated in chancre with raised edges, easily bleeding, and 
often profusely; superficial or elevated ulcer with zig-zag edges, 
when no signs of central granulation are present, or if they are, they 
are pale and iiabby ; ulcers with a thin ichorous discharge, and a 
dark, dirty base. 

Arsenic, when the chancre becomes gangrenous, or phagedenic ; 
ulcers with a thin, offensive discharge, hard, readily bleeding edges, 
and proud flesh ; gangrenous ulcers with bloody edges ; painless 
ulcers with hard edges ; ulcers secreting a copious watery, fetid 
ichor ; persons who love warmth. 

Thuya, for elevated ulcers with exuberant granulations ; flat 
ulcers, with unclean base and red edges ; pale red vesicles about the 
ulcers. A very useful medicine in cases that resist Nitric Acid. 

Aconite is sometimes temporarily useful for the inflammatory 
chancre, or when the exhibition of Mercury is followed by violent 
inflammation. 

Argentum nitras for small ulcers, which spread slowly, and are 
covered with a lardaceous substance. Silicse, in scrofulous individuals, 
when the ulcer discharges an excessive amount of fetid, thin and 
bloody ichor. Causticum, when the discharge is acrid and corrosive, 
gouty, scorbutic or ill-nourished persons. Sulphur in psoric consti- 



HEMORRHAGE. 



tutions, when other remedies do not act, especially for superficial ulcers 
and excoriations, or for torpid ulcers ; sores with the characteristic 
lardaceous secretions and discharge of fetid ichor. 

Lachesis should be thought of in gangrene, and in ulcers sur- 
rounded by a bluish halo. 

Iodine has cured quite a number of cases after the inguinal 
glands have become implicated. The urine has an ammoniacal odor. 
Corralium has served us in a few cases after the failure of mercury. 

Other remedies might be mentioned, such as Aurum, Hepar, 
Staph, etc. The potency to be used is probably not as important as 
the right remedy. We use the higher potencies almost invariably, 
while others claim equal success with the lower. But we must cau- 
tion you against using mercury below the third, as bad results are 
very apt to follow. 

As has already been stated, hemorrhage sometimes arises during, 
the progress of chancre, and it should be arrested at once. If the 
hemorrhage occurs from the destruction of some vessel, the com- 
pressing forceps or the ligature will be required, which, however, 
does not always arrest it ; if from a number of points there is constant 
oozing, use compresses soaked in hamamelis. or, if still unarrested, 
some styptic, such as the persulphate of iron, should be employed. 
Nitric acid internally is very valuable. The treatment of erections, 
which are sometimes quite frequent, will receive special attention when 
we speak of gonorrhoea. 

Chancre sometimes occurs in the urethra, and is then often mis- 
taken for gonorrhoea on account of the similarity of the discharge. 
It is of the utmost importance to distinguish between these affections, 
and all cases should be very carefully examined. When the sore is 
just within the meatus, its most frequent site, there is but slight lia- 
bility of being mistaken, for, on spreading the lips, it will be exposed 
to view ; but when it occurs some two inches or more from the ex- 
tremity of the penis (in the membranous and prostatic regions), the 
diagnosis is often difficult. Chancres have been found by Ricord to 
extend along the whole of the urethra. The discharge is usually 
much less than in ordinary gonorrhoea ; it is also thin or of a lighter 
color, mingled with streaks of blood. When the accompanying in- 
flammation is unusually severe, it may be both profuse and of a thick 
bloody character, or thick and yellow with a greenish tinge. The 
smarting, burning pain during micturition is referred to a limited por- 



CHANCRE OF URETHRA. 27 

tion of the canal, and is not so great as in gonorrhoea, while the site of 
the urethral chancre is nearly always indicated by a kernel of indura- 
tion, easily distinguished by the thumb and finger. Erections are 
not as frequent nor as painful as in gonorrhoea. Chancre in the ure- 
thra, as elsewhere, may be followed by secondary symptoms. Bubo 
is a rare complication, but contraction of the urethra is nearly always 
one of its effects. The only positive diagnostic characters of chancre 
in this situation are furnished by inoculation. The induration may 
exist in gonorrhoea in consequence of the development of an abscess, 
and from other causes ; the discharge, if profuse and thick, is not 
diagnostic ; the scalding during micturition may be slight also in gon- 
orrhoea, and the extraordinary length of time between the indiscre- 
tion and the onset of the disease may also be present in gonorrhoea. 
It should have been stated before that the period of latency of chan- 
cre in the urethra is much longer than when in other situations, on 
the theory that the quantity of virus is small, or that the virus be- 
comes entangled in one or more of the lacunse of the tube, and is in- 
capable of exciting the same influence as when brought in contact 
with an abraded surface. If urine is passed soon after the virus is 
introduced into the urethra, it is either washed way or neutralized by 
this fluid. 

The treatment of chancre in the urethra will vary according to 
circumstances. If the sore can be seen by separating the lips of the 
meatus or by the ear speculum, the treatment just given for chancre 
in other situations will be applicable ; if not, we must depend entirely 
on the symptoms given by the patient, and then the treatment does 
not differ materially from that of gonorrhoea. The remedies will be 
mentioned when we speak of the latter affection. 

Chancre in the female necessarily requires the same treatment as 
in the male. The seat of the sore is more often the vulva than else- 
where, although, as we have already remarked, the vagina and uterus 
are sometimes affected. The chancres are sometimes concealed, or 
partially so, between the rugae of the skin on the external genitals as 
well as in the vagina, especially when the sores are small. Females 
are more often affected with the soft variety of chancre than the in- 
durated, and the pain is much greater than in the male. Frequent 
washing of the parts is absolutely necessary, as is rest, also, if there is 
much inflammation of the parts. 

Chancre appears, as has been before stated, on the fingers, lips, 



28 PHYMOSIS AND PARA PHYMOSIS. 

tongue, eyes, nose, cheek, scalp (rarely), anus, trunk, extremities, etc./ 
wherever the virus has been accidentally or purposely inoculated, and 
the diagnosis is deduced from the history of the case, and a very care- 
ful observation of the suspected ulcer. No matter what the situation, 
the treatment is the same, viz., frequent cleansing of the part, and the 
administration of that remedy which covers the most symptoms in 
the case. 

Phymosis is that condition of the penis in which the prepuce can- 
not be drawn back of the corona glandis, and does not require any 
special attention. It is a very inconvenient complication as it pre- 
vents our ascertaining the exact condition of the ulcer, and may cause 
gangrene. It is caused, when not congenital, by the infiltration of 
fluid into the cellular tissue of the prepuce, forming a bulbous swell- 
ing at the extremity of the penis, its borders being usually inflamed, 
enlarged, cracked, and often so narrow that but a small portion of the 
secreted pus can make its escape, thus rendering the retraction of the 
prepuce behind the glans impossible, the retained pus collecting un- 
derneath and forming a fluctuating swelling. Blenorrhoea is almost 
always present, and persons with a long, narrow prepuce are most sub- 
ject to phymosis. The remedy administered for the chancre is usually 
sufficient for the cure of this complication, but in some cases Rhus tox~ 
is required, when there is a puffy swelling of both prepuce and glans, 
with itching and moist eruption on the scrotum. 

Apis may be of service if the swelling is of a dropsical character, 
the parts being tense, shining and transparent. 

Sulphur is valuable in scrofulous patients when other remedies 
have failed. 

Cinnabar is indicated when there is a dark red, hot and inflamed 
prepuce. 

If gangrene threatens, the knife should be used dividing the parts 
carefully, and immediately washing the edges with a solution of car- 
bolic acid. Above all, do not forget to insist on cleanliness. Order 
the patient to inject under the foreskin a little carbolized water sev- 
eral times a day. 

Paraphymosis, that is retraction of the prepuce behind the glans 
so that it cannot again be brought forward, is occasionally present, 
and is a much more dangerous complication than phymosis, for, if the 
constriction is not immediately relieved, it may cut off the circulation 
of blood in the glans, and eventually lead to swelling, inflammation 



BUBO. 29 



and gangrene of the part, a frequent result. An effort should be 
made at once to restore the parts by manual efforts aided by chloro- 
form. Before attempting reduction, the penis should be soaked in 
cold water, and the swollen part kneaded between the fingers. Ii 
this fails, as it not unfrequently does, there is no remedy but the 
bistoury ; a narrow-bladed one is the best to slip beneath the con- 
stricting ring formed by the prepuce, and it should be carried back 
toward the pubes, and then turned cutting outward. In milder cases, 
the same remedies that are recommended for phymosis may be used 

Bubo, strictly speaking, is an enlargement of one or more of the 
lymphatic ganglions of the groin, although the term with propriety 
may be and has been applied to any engorgement of the lymphatic 
ganglia. Anything tending to irritate and inflame the lymphatic 
vessels leading to these glands may produce it. The most frequent 
causes being excessive sexual indulgence, strains, gonorrhoea, catarrhal 
or cutaneous inflammation, fatigue from protracted exercise, forced 
marches, injuries of the lower extremities, tight boots, or the presence 
of a boil on the thighs, nates or perineum. It occasionally occurs 
without known exciting cause. The inflammation attacks the glands 
nearest and in direct communication with the ulcer, and almost in- 
variably the ganglia of the superficial chain. 

Bubo is very liable to occur in young people of a scrofulous dia- 
thesis, often arising from the most trivial causes and disappearing 
usually without much treatment. Bubo, however, arising from syph- 
ilitic cause is a specific disease, the result of inoculation with the 
virus of chancre, and eventually furnishes a secretion similar to that 
by which it was itself produced. An open or suppurating syphilitic 
bubo is really a chancre, and is merely a primary form of disease. 
The syphilitic bubo arises two or three weeks after the first appear- 
ance of the primary sore ; in a few instances coming on as early as 
the eighth day, and in others the time is postponed for even four or 
five weeks. 

Bubo follows both varieties of chancre. Gross says : " An active 
open state of the ulcer, and the smallest conceivable amount of in- 
flamation in the structures immediately around, are, other things 
being equal, the conditions most favorable to the development of the 
true syphilitic bubo." 

The hard chancre is always followed by bubo, while the soft is 
thus followed only once in three times. The swelling after hard 



30 SYPHILITIC BUBO. 



chancre involves several gaDglions, and is hard and chronic, with very 
slight disposition to suppurate ( if pus does form it is not considered 
specific ), although all authorities contend that it is sure to contami- 
nate the system. On the other hand, the bubo following soft chancre 
usually affects but one gland, runs its course rapidly, terminating in 
an abscess, the discharge being abundant and of a specific character. 
The bubo generally forms on the side on which the chancre is situ- 
ated, and exceptionally and rarely on the opposite side. A very bad 
form of bubo occasionally occurs at the root of the penis, or upon the 
pubes, caused by the presence of an infected ganglion. 

Males suffer much more frequently from bubo than females, 
owing to the difference in the arrangement of the lymphatic vessels — 
those in the male passing directly from the seat of the disease, while 
the course is more circuitous, in the woman. In chancre of the 
uterus and upper part of the vagina, bubo is uncommon, and the 
same is true in chancre of the urethra in men. The older writers on 
syphilis asserted that a syphilitic bubo occasionally occurred without 
the intervention or antecedence of chancre, and this was called a 
primary bubo. This theory was incorrect, the proof insufficient, and 
fortunately has but few partisans at the present day. It may happen 
that the chancre is quite small, and thus escape the attention of both 
patient and physician, for there is no reason to doubt that very small 
and insignificant ulcers sometimes appear on the genitals and are 
followed by violent constitutional symptoms. 

A bubo is a very* uncertain kind of swelling ; it may remain sta- 
tionary for a number of weeks or months, or it may become hardened, 
the latter being considered a dangerous form by those who do 
not think chancre a constitutional affection, as they claim that one 
can hardly escape contamination of the system when this occurs. 
Gross calls the bubo a hot-bed, not merely for the temporary lodgment 
of the virus, but for its zymotic operation and its gradual extension 
to other and more important structures. When a bubo suppurates, it 
is important that the matter should be evacuated early, otherwise the 
pus is apt to burrow among the neighboring tissues, causing an ex- 
tensive sinus. The discharge from an open bubo varies greatly, 
sometimes being thin and ichorous ; at others, thicl^ yellow and 
bloody, although there is seldom hemorrhage. The edge of the sore 
exhibits about the same appearance as that of an ordinary chancre, 
and the bottom is covered with a dirty, greenish or yellowish mat- 



SECONDARY SYPHILIS. 31 

ter. This open bubo may become phagedenic the same as a 
chancre, and then produces just as frightful a destruction of tissue. 
Again, it may become gangrenous — true gangrene, which latter com- 
plication only occurs in half-famished, dirty persons, who have no 
regard for cleanliness, the inmates of prisons, almhouses, cellars and 
other foul habitations. These patients usually die under the regular 
practice. 

There is a form of bubo called the creeping, which is the exact 
counterpart of the serpiginous chancre, creeping snake-like about in 
different directions. Syphilitic bubo is liable to be confounded with 
bubo from other causes, but the following points render the diagnosis 
comparatively easy, viz.; the history of the case ; the syphilitic bubo 
comes on about two or more weeks after the chancre ; the common 
in one or two days after the exciting cause ; the syphilitic bubo lasts 
several weeks or months, the common disappears with the exciting 
cause ; the first suppurates and ulcerates, the latter hardly ever, ex- 
cept in scrofulous persons ; the pus from one is inoculable, from the 
other, never ; the syphilitic bubo is situated above Poupart's liga- 
ment, affecting generally but one gland — the common below, or under 
the ligament affecting several glands usually. 



SECONDARY SYPHILIS. 



This brings us to secondary syphilis, another step in the progress 
of the disease. This stage follows the primary sore in from four to 
twenty weeks, the average time being six weeks, and is transmissible 
by hereditary descent. In general terms, the tissues now affected are 
the skin and the mucous membranes, not necessarily both at the 
same time, but sometimes the skin, at others the mucous membranes, 
and again both. The exact time of the appearance of secondary 
symptoms cannot be foretold, as much depends upon the mode of 
life of the patient and his personal idiosyncrasies. Occasionally we 
find rheumatic pains present during this stage, but these do not by 
any means denote affection of the bones. What the poison is and 



32 SECOND A RY S YPIIILIS CONTA 010 US. 

where it resides are questions which are still undecided, and which 
we have already discussed. We know, however, that it circulates in 
the blood. These symptoms follow both varieties of chancre, but 
more often the hard, and are never present except when hereditary, 
without a previous history of one on the other variety of chancre. 
It is not uncommon for these symptom to present themselves before 
the chancre or bubo has disappeared, but usually if the patient is 
under proper treatment the primary sore has entirely disappeared, 
and the sufferer imagines himself well before they make their appear- 
ance. 

The following facts should be carefully noted: 1, That the hard 
chancre is nearly always followed by secondary symptoms; 2, That 
the soft chancre is also followed by secondary symptoms, if multiple 
or of great extent ; 3, That secondary symptoms are contagious and 
inoculable ; 4, Chancres which become gangrenous are not apt to 
affect the system ; 5, Feeble and scrofulous persons are more liable 
to secondary than healthy persons; 6, Mercury is a predisposing 
cause of secondary syphilis ; 7, Chancre of the urethra is rarely fol- 
lowed by constitutional contamination ; 8, If the local inflammation is 
unusually severe, secondary symptoms rarely occur. The foregoing 
points should be remembered, for on them you base your prognosis. 
Secondary syphilis is both contagious and inoculable, and produces 
a degree of contamination which is almost impossible to cure without 
prolonged and skillful treatment. If we take upon a lancet a small 
portion of the serum of the blood of an infected person and insert it 
into the arm of a healthy person, a chancre will be the result. This 
same serum, however, will have no effect upon the arm of the person 
from whom it was taken, or upon any other syphilitic individual. 
The period of incubation after inoculation is from twenty to forty 
days. We have already referred to the propagation of syphilis by 
means of vaccination, the lymph used having been contaminated with 
the blood of the affected individual. In this connection it may not 
be amiss to say that writers upon this subject formerly believed that 
syphilis once implanted in the system never could be eradicated, and 
that it ran through one generation after another; but these views 
are not held at the present day, and syphilis is considered a curable 
disease. Our own experience teaches us that many of these patients 
are thoroughly cured and afterward give birth to healthy children, 
entirely free from all traces of this dreaded malady. 



SYMPTOMS OF SECONDARY SYPHILIS. 38 

The symptoms first noticed in the invasion of secondary syphilis 
are very variable. The following are often noticed, not all of them 
by any means in any given case, but one or more of them, and of 
varying intensity. For a number of days, previous to the eruption, 
the patient complains of malaise ; he is not really sick, and yet he is 
not well ; has some dizziness at times ; headache on one side only at 
night ; he is gloomy and low-spirited, with aversion to doing any- 
thing ; has the blues in fact ; his appetite is impaired ; his breath is 
short, with a quickened pulse, and his heart palpitates from time to 
time; his limbs and joints feel sore and stiff, especially at night; he 
has a pain under the sternum, with some tenderness to the touch ; 
his look is dull and heavy ; there is more or less gastric trouble, with 
constipated bowels ; the urine is scanty, and high colored, with acid 
re-action ; he is easily fatigued ; his limbs are numb ; his sleep is 
restless, and full of anxious dreams. The post cervical glands will 
be found indolently indurated at this time, and the hair will com- 
mence thinning out, as the result of feebleness. 

A few days after, he has what is termed the syphilitic fever ; that 
is, he is suddenly seized with chilly sensations or rigors, followed by 
moderate fever (occasionally very high fever), or by fever and profuse 
morning sweats, reminding one very forcibly of the sweats of pulmo- 
nary tuberculosis. The type of the fever bears a great resemblance, 
at times, to intermittent or remittent fever, and at others to rheu- 
matic fever. This fever is present in only twenty-five per cent of the 
cases. The eruption now makes its appearance, and the fever soon 
disappears, and with it the other general symptoms mentioned a 
moment ago. In place of the eruption upon the skin, we may have 
an affection of the mucous surfaces. 

The skin eruptions are of an erythematous, scaly, papular, tuber- 
cular, vesicular or pustular character, differing in intensity in different 
individuals. No two cases are exactly alike, although all present a 
striking family likeness. Some of these eruptions belong to both the 
secondary and tertiary stage, because we cannot, as yet, exactly define 
the limits of each definitely. In fact, we cannot say that any one 
variety belongs exclusively to either secondary or tertiary syphilis. 
It is almost impossible to give any general characteristics that shall 
apply equally to all syphilitic eruptions. We are only able to give 
some general rules which have some exceptions. They often present 
varied lesions side by side ; macules, papules, pustules, may be asso- 



34 ERYTHEMATOUS ERUPTION. 

ciated together. They pursue a chronic course, and occur upon all 
parts of the body, but more especially upon the inside of the arm and 
thigh, face, forehead, nose, back and shoulders. They are not always 
of a copper color in their earlier and more acute stages, but invariably 
present this appearance after a time. They are readily distinguished 
from non-specific skin diseases by the history of the case ; by the 
absence of heat, itching and pain ; by the peculiar copper color ; by 
the tendency to destroy the tissues on which they are seated, and by 
the concurrence of lesions of the integument and mucous mem- 
branes. 

The erythematous form, the earliest and the most common, some- 
times comes on before the disappearance of the primary symptoms, 
usually in about two months. It may appear suddenly or gradually, 
with or without pyrexial disturbance, the spots appearing on the 
skin and mucous membrane, at first of a red color, then coppery. 
They are of circular shape, i to | inch in diameter, and do not pro- 
ject above the level of the skin. They are most prominent and 
numerous on the thorax and belly, although they may appear upon 
any portion of the body ; they do not entirely disappear under pres- 
sure ; are rarely, if ever, confluent, healthy skin existing between 
them, and usually pass off with a very slight desquamation of the 
skin. Oftentimes, the spots are considerably smaller, more irregular 
in shape, and of a brighter red color. This variety, the mildest of 
all syphilitic eruptions, has received the name of roseola, from its 
great resemblance to measles. The physician frequently is the first 
to discover it, as there is no itching, heat or pain. It is found all 
over the body, except the sides of the neck. There is no perceptible 
elevation of the skin in either variety. After ten days, more or less, 
the eruption fades and becomes dingy or grayish brown. Its duration 
varies from a few days to four or more weeks, and it may relapse. 
The history of the case, the absence of itching, its location, and other 
differences just mentioned, distinguish it from other skin diseases for 
which it mighjt be mistaken. It lacks the catarrhal symptoms of 
measles, and hence could not be confounded with rubeola. 

The scaly variety of syphilis makes its appearance from six to ten 
months after the primary disease, and usually without any marked 
precursory symptoms/ It may form the connecting link between sec- 
ondary and tertiary syphilis, or may belong wholly to one or the other 
stage. It is quite generally associated with other well-marked symp- 



SCALY AND VESICULAR ERUPTIONS. 35 

toms, such as inflammation of the throat and palate, iritis, and bone 
pains of greater or less intensity. The eruption generally occurs in 
small patches of an irregular or circular shape of a red and somewhat 
coppery color, and is most common on the forehead, scalp, face, arms 
and palms of hands and soles of feet, although it may appear upon 
any part of the body. The scales are distinct, hard but Small, of a 
dull, opaque-grayish or whitish appearance, or they may be thin and 
filmy, resting upon a copper-colored base. Often they are circular in 
form and slightly depressed in the center, the skin underneath show- 
ing a tendency to ulcerate or to form cracks and fissures. If ulcera- 
tion does take place, a thick, brown, dry crust soon forms. When 
the ulcer has healed, a whitish cicatrix, somewhat depressed in the 
center, remains to mark the original site of the sore. The most fre- 
quent form of this variety is psoriasis palmaris and plantaris. This 
affection commences with the appearance of from three to a dozen or 
more small, flat papules, devoid of itching or pain, which increase in 
size, forming irregular patches by fusion, after a time. The papules 
are prone to seek the furrows in the hand, and it is here that we 
most frequently see the disease as a true scaling syphilide. The 
diagnosis is sometimes quite difficult. The history of the case should 
be carefully considered, and the co-existence of other lesions sought 
for. Ordinary psoriasis is not usually confined to the hands and feet 
but "occurs elsewhere at the same time. 

The vesicular variety of syphilis is of very rare occurrence, is al- 
ways chronic and greatly resembles eczema and herpes in its general 
characters. Its favorite site is the neck, chest and extremities, the 
face usually escaping. In very rare cases, the vesicles are so numer- 
ous as to cover nearly the whole surface of the body. When present, 
it marks the transition of primary into secondary syphilis, coming on 
as it does about eight weeks after the appearance of the chancre, 
The eruption appears first as minute circumscribed pimples, soon 
changing to vesicles filled with a transparent serous fluid, and sur- 
rounded by the characteristic copper-colored areola. The contents 
may become turbid and purulent, but are finally absorbed or dry 
down into thin scales, which, when they fall off or are removed, leave 
the part a dirty yellow hue. As accompanying symptoms usually 
present, we may mention rheumatic pains in the bones and joints, and 
dryness of the throat. The diagnosis is frequently difficult without 
the previous history of the case, for there is nothing aside from the 



36 5 YPHILITIC B ULL^J. 

copper-colored areola to distinguish it from other vesicular dis- 
eases. 

Syphilitic bullae are simply enlarged vesicles, and appear as pem- 
phigus and rupia. Pemphigus i3 subacute and transcient in its char- 
acter, is rather rare and appears early in secondary syphilis, but never 
except in children, as the first eruption. In children of syphilitic 
parents, it is not uncommon, and nearly all the little ones die. Hepar 
sulph. served us well in one case. The vesicles usually run an indo- 
lent course after their contents become pustular, do not increase 
much in size, and finally crust over. These crusts, on falling off, leave 
pigmented spots. Rupia is more common, appearing sometimes dur- 
ing the first year, but usually very late in the disease. It is essen- 
tially a disease of adults, and pursues a very chronic course. All 
the lesions of rupia begin as a red spot, which soon is the seat of a 
large or small bulla, the contents of which soon become purulent, and 
then dries into a yellow or greenish brown crust of variable size, but 
usually one-eighth to one-fourth of an inch in diameter. Underneath 
this crust is an ulcerated, infiltrated surface, which extends somewhat 
beyond the original crust. As they grow older and new additions are 
added from the bottom, gradually elevating the mass, the crusts be- 
come darker and the base presents the usual copper-colored areola. 
The lower crust may grow to the size of three or more inches in 
diameter. The scabs constantly cover foul ulcers, for if at any time 
we remove the oyster-shell as it is called, we find a foul, grayish look- 
ing ulceration, which again becomes crusted over, and thus it con- 
tinues until influenced by anti-syphilitic remedies. Rupia may occur 
anywhere on the body, but usually selects the forearms or lower ex- 
tremities. In the worst case which ever came under our observation, 
the forehead was the seat of the disease, which is rather an infrequent 
place for its development. There is no pain at any time. The diag- 
nosis is easy, as there is but one other disease which at all resembles 
it, and that is psoriasis rupioides ; but in the latter affection there is 
a want of the characteristic dirty color of the scabs and the copper- 
colored areola. The prognosis should be guarded, as this is an affec- 
tion of considerable gravity and really belongs to the tertiary stage. 

Syphilitic pustules are less common than erythematous and papu- 
lar eruptions, but present similar appearances outwardly to other pus- 
tules, except that each pustule rests upon a hard copper-colored base. 
They are found upon any part of the body, scalp, face or extremities ; 



PUSTULAR ERUPTIONS. 37 

they rnay be single, multiple or confluent ; their shape is round or 
oval ; the size varies from that of a pin's head to that of a hazel nut. 
They occasionally exist as the earliest eruption at six weeks, or with 
the primary disease ; but no matter when they appear, they always de- 
note a severe constitutional contamination. The number of these 
pustules varies greatly, sometimes being so numerous that hundreds 
are scattered over a small surface, and the suffering and exhaustion 
may be so great as to destroy life. They may begin as papules or as 
distinct pustules, and relapses are very common. There are two 
varieties, the one termed psydracious in which the pustules occur in 
groups, and the other phlyzacious in which they are scattered. After 
two or more weeks, the contents of the pustules escape, concrete and 
form scabs of a varying thickness, of a yellow or greenish black color, 
and quite firmly adherent. In simple cases under small crusts, there 
ns usually little if any ulceration, but a chronic induration, a dusky 
stain or a small cicatrix. In severe cases under larger crusts, deep, 
circular ulcers are exposed with a foul, grayish bottom, or a covering 
of thick, yellow pus. The edges are circumscribed, perpendicular, and 
often undermined ; in healing, a white indelible scar remains. These 
ulcerations are long-lasting and very difficult to heal. This form of 
syphilis is often a connecting link between the secondary and tertiary 
stage ; is sometimes associated with iritis, and with the tubercular and 
papular eruptions, and less frequently with roseola and the squamous 
forms of syphilis. If high fever accompanies, it may be mistaken for 
small-pox, but a day or two clears up the diagnosis. 

We have a form of syphilitic acne which appears in the secondary 
stage (third to sixth month), accompanied by fever. The pustules 
are scattered over the whole body, thus differing from ordinary acne, 
which is confined mainly to the face and shoulders. The general 
health is more frequently impaired after this rash than after others. 
After the disappearance of the pustules, small brown spots remain for 
some time, and exceptionally, minute cicatrices. 

Syphilitic ecthyma appears during the first year, and is dis- 
tinguished from non-specific disease by the history of the case, the 
absence of itching, and light inflammatory action. A guarded prog- 
nosis should be given in these cases. 

The tubercular form of syphilis, the most formidable and most 
frequent of all, is really an exaggerated form of syphilitic papules. 
It makes its appearance at any time, from one to twenty years after 



38 TUBERCULAR SYPHILIS. 



the primary sore, in cases that have not been properly treated. The 
tubercles begin as small, red, copper-colored eminences, which slowly 
increase in size, until when fully developed, they are as large as an 
olive or an orange. They may occur upon any part of the body or 
face, and possess a decided tendency to ulcerate. They are of a 
rounded, flattened or conoidal shape, isolated in groups, or arranged 
in perfect circles or segments of circles. They are smooth, and have 
a shining appearance ; cause little or no pain, heat or itching, and 
become covered in a short time with a dry, scaly incrustation, very 
similar to psoriasis, which is generally reproduced as fast as it falls 
off. In the aggravated form, the tubercles are very large, from A to 
1 inch or more in diameter, at first of a dark red, or a light pink 
color, becoming a deep, violet hue, and surrounded by a well-marked 
copper-colored areola. The course of the eruption is very slow, but 
in a few months or years a number of the tubercles inflame and 
suppurate, giving rise to deep, foul, painful ulcers, with sharp-cut 
edges, resting upon a hard base. Such cases, fortunately, are very 
rare. The thick, greenish-black crust, which covers the ulcer, is 
frequently renewed, showing, when removed, that the sore is con- 
stantly spreading. In broken-down subjects, or drunkards, the ulcers 
may merge together, forming sores of frightful size, which, in heal- 
ing, leave disfiguring scars, somewhat depressed. It should be remem- 
bered that syphilitic tubercle is a very serious form of disease, as it 
may last a long time, exhausting the patient, and the eruption may 
be kept up by successive outbreaks. Relapses occur even when we 
have every reason to expect continued improvement from skillful 
treatment. 

There are two varieties of papular syphilis, which may appear as 
the first eruption on the skin, or may be associated with roseola. 
The first consists of very small, hard, solid elevations, about the size 
of a pin's head or larger, conical or rounded, disjointed or grouped, 
devoid of fluid, and terminating in desquamation. They may appear 
upon any portion of the body, but seem to prefer the anterior part of 
the trunk. The papules are sometimes umbilicated ; are of a pale 
rose color at first, and afterward of a coppery red, and are surrounded 
by violet areolae, which are often confluent. The color disappears 
under pressure at first, but not at a later stage. They appear simul- 
taneously upon different parts of the body, backs of the hands, scro- 
tum, penis, and often the face (similar to acne), disappear in a short 



PAPULAR ERUPTIONS. 39 

time, and are followed by desquamation of the skin, rarely resulting 
in ulceration. Upon the scrotum and penis, however, they usually 
become excoriated, and are then transformed into condylomata. Fre- 
quently, these papules are seated at the openings of follicles, a feature 
rarely noticed in any other form of syphilitic papule. After their 
disappearance, pigmented spots remain, which become white only 
after a number of weeks. In the other variety, the eruption is de- 
veloped gradually, commencing with minute, yellow spots, which rap- 
idly increase in size, and are located on the forehead, scalp and upper 
and lower extremities. The papules are larger than the other variety, 
with a diameter of from \ to J inch or even more. They are flat, 
round or oval, grouped, of a light, red color, soon becoming coppery, 
and devoid of an areola. The surface of the papule becomes covered 
with a thin, dry, grayish pellicle, which is re-formed as fast as it is 
thrown off, until the disease is finally arrested. The skin between 
the papules becomes dry and shriveled, of a dingy, yellowish color, 
and is apt to be the seat of a constant exfoliation of the skin. No 
scars are left upon its disappearance, simply pigmented spots. Upon 
surfaces that are moist, as the perinaeum for example, the papules 
become transformed into condylomata. This result is usually met 
with during the second or third year of syphilis, and very rarely 
during the first twelve months. The earlier its appearance, the more 
copious is the eruption ; the later it comes on, the more apt it is to 
be accompanied with iritis, alopecia, condylomata, and pustular 
eruptions on the hairy parts. 

Treatment. Our old school friends recommend mercury, tartar 
emetic, iodide of potash, etc., etc., for the different variety of skin 
affections, combining them with aconite for violent fever, with mor- 
phine for restlessness, sleeplessness, etc., with sulphate of magnesia 
for constipation, etc., etc. It will be difficult to give you the Hom- 
oeopathic treatment for these eruptions without other symptoms, so 
we shall content ourselves with a brief resume of the more impor- 
tant only, recommending that in every case you should note carefully 
all the symptoms and select a remedy in accordance with them : 

For syphilitic erythema and roseola — Aurum, Ant. crud., Ant. 
tart., Ars., Bell., Calc, Canth., Lye, Merc, Nit. ac, Phos., 
Sulph., Sulph-ac, Tereb. 

For squamous or scaly diseases — Alum, Alum carb., Ars., Ars. 
jod., Aur., Bry., Calc, Carbol. ac, Clem., Coral., Dulc, Hep., 



40 TR EA TMENT—A L OP EOT A . 



Iris., Kali, brom., Led., Lye, Merc, Nitr. ac., Petrol., Phos. T 
Phos-ac, Phytol., Psor., Rhus., Sep., Sulph., Tell., Teucr. 

For vesicular — Amm. c., Ant. c., Ant. t., Arg., Ars., Aur. y 
Brom., Bry., Calc, Canth., Carbo. veg., Garbol. ac, Clem., Dulc, 
Graph., Hep., Iris.^ Kali., Lach., Led., Lye, Merc, Mezer., Natr* 
m., Nitr. ac, Petr., Phos., Rhus., Sep., Sil., Staph., Sulph., Thuj. 

For pustular — Alum, Alnus, Amm. c, Ant. c, Ant. t., Ars., 
Ars.jod., Baryta., Calc, Carbo. veg., Carbol. ac, Caust., Con. y 
Dulc, Graph., Hep., Kali., Kreos., Lach., Lye, Merc, Natr. m., 
Nitr. ac, Phos., Phos. ac, Rhus., Sarsap., Sep., Sil., Staph. T 
Sulph., Viola. 

For papular — Ars., Bry., Calc, Caust., Cicuta., Con., Dulc, 
Graph., Lye, Merc, Mur. ac, Nitr. ac, Phytol., Puis., Rhus. y 
Sil., Staph., Sulph., Thuj. 

For tubercular — Same remedies as papuiar. 

Alopecia, or falling out of the hair, is more a symptom than a 
disease, and may arise during the course of many other acute and 
chronic diseases. When due to syphilis, which is of very common 
occurrence, it generally commences within eight or ten weeks, dating 
from the commencement of the primary sore, and is attended by no 
marked subjective symptoms as heat or itching. It arises gradually, 
the hair coming out when combed or pulled, in patches or circular 
disks of variable size. Upon examining the head well-marked cop- 
per colored spots will be found as a rule. It varies greatly in de- 
gree, being generally quite moderate, but in some cases not only the 
hair of the head, but that of the face, pubes, genitals and other por- 
tions of the body, falls out. The hair first becomes unusually dry, 
loosing its soft and glossy feel, and is stiff and brittle, soon afterward 
falling out in great abundance, leaving exposed to view circular 
blotches of a dusky, copper color. Accompanying this affection we 
usually find wandering rheumatic pains in the muscles, bones and 
joints. Even in very severe cases, in persons of middle age, we may 
expect the hair to grow again, but it is never as soft and glossy as 
before, but becomes coarse, stiff and sparse. Ulcerating eruptions 
which affect the scalp sometimes destroy the follicles, and in such 
cases we expect as a matter of course permanent bald spots as the 
result. Alopecia is due to the impaired nutrition of the hair folli- 
cles, occasioned by the adynamic influence of syphilis. 

The following remedies are valuable for falling out of the hair : 



ADENITIS. 41 



Alum, Ambr., Amm., Amm. m., Ant. c, .Ars., Aur., Bar., Bell., 
Bor., Calc, Canth., Carbo. an., Carbo. veg., Caust., Chel., Colch., 
Coil. t Creos., Cycl., Dulc, Ferr., Graph., Sell., Hep., Ign., Iod., 
Kali., Lack., Lye, Mezer., Magn., Merc, Natr., Natr. m., Nitr. 
ac, Op., Par., Petr., Phos., Phos. ac, Plumb., Rhus, Sarsap., 
Sabin., Sec. corn., Helen., Sep., Sil, Staph., Sulph., Sulph. ac, 
Zinc 

Falling out in tufts, Phos. 

Falling out in circular patches, Ars. 

Falling out from back of head, Calc, Carbo. veg., Hep., Petr. , 
Sep., Sil., Staph., Sulph. 

Falling out from crown of head, Bar., Calc, Carb. an., Phos., 
Hep., Lye, Nitr. ac, Plumb., Selen., Sep., Sil., Zinc 

Falling out from forepart, Ars., Bell., Hep., Merc, Natr. m., 
Phos., Sil. 

Falling out from sides of head, Bov., Graph., Kali., Phos. ac, 
Staph., Zinc 

Falling out from temples, Calc, Kali., Lye, Merc, Natr. m. r 
Par., Sabin. 

Falling out from eyebrows, Agar., Bell., Caust., Hell., Kali., 
Mezer., Par., Plumb., Selen. 

Falling out from whiskers, Agar., Ambr., Calc, Graph., Natr. t 
Natr. m., Nitr. ac, Plumb., Sil. 

Falling out from moustaches, Bar., Kali., Plumb. 

Falling out from nostrils, Calc, Caust., Graph., Sil. 

Falling out from genitals, Bell., Hell., Natr., Natr. m., Nitr. 
ac, Rhus, Selen, Zinc 

Falling out from body generally, Ars., Calc, Carbo. v., Graph. 
Hell., Kali., Natr. m., Op., Phos., Sabin., Sec corn., Sulph. 

Hair brittle, Ars., Bell. ■ 

Hair dry, Aloe, Alum., Bad., Chel., Hip., Kali., Phos., Sec. 
corn. 

Hair stiff, Ars., Canth. 

We have already spoken briefly of cervical adenitis. Suffice it to 
say that usually the posterior cervical glands become affected at a 
very early period of secondary syphilis, becoming enlarged to the 
size of an almond, and slightly tender at first, though never pain- 
fully so. It will be remembered that in health these glands are so 
small that they can scarcely be detected. This engorgement of 



42 ERYTHEMA OF MUCOUS MEMBRANES. 

glands at a distance from the primary sore and at about the sixth or 
seventh week, is considered the earliest and most characteristic symp- 
tom of secondary syphilis. It is present in over ninety per cent of 
all cases. There are seldom more than one or two glands involved, 
although in very rare cases there may be as many as six or eight. 
The posterior cervical glands referred to are situated along the upper 
half of the posterior border of the sterno-cledio-mastoideus muscle. 
The glands never suppurate, at least there is only one case on record 
showing an exception to the rule. The duration of these glandular 
indurations is quite protracted. This enlargement of glands is only 
important from its constancy as a means of diagnosis, and is some- 
thing the physician should never fail to look for in cases of difficult 
diagnosis. They require no special treatment, as the remedies 
adapted to the other symptoms present remove this affection also. 
The remedies exerting a special curative action on these glands are 
Bar., Code, Hell., Iod., Mur. ac, Petr., Phos., Sil., Sulph. 

We shall next consider the various affections of the mucous mem- 
branes, bearing in mind that while the cutaneous and mucous surfaces 
are but one continuous membrane, the constant moisture, exposure to 
friction, etc., of the latter, very greatly alters the character of the 
various eruptions. These affections, as we have already stated, may 
exist with the eruption upon the skin or independently of it ; but, as 
a rule, both structures are affected at the same time. They make 
their appearance usually after the chancre has disappeared, but in 
many cases even before this has occurred, The parts most frequently 
attacked are the tonsils, palate, pharynx, tongue, cheek and lips, al- 
though any portion of the mucous membrane which is visible may be 
affected. As regards the stomach and bowels, all we can say is that 
nothing satisfactory is known, although the anus and rectum are fre- 
quently involved. It is not known positively whether the urinary 
organs are ever affected. These eruptions appear frequently upon the 
foreskin, head of the penis, the vulva, the vagina and the uterus- 
They manifest themselves in a variety of forms, sometimes as an ery- 
thematous disease, corresponding to the roseolar form of cutaneous 
syphilis ; sometimes as tubercle, corresponding to squamous syphilis, 
and again as an ulcer crack or fissure. These three forms may co- 
exist in some cases. 

One of the earliest and most common manifestations is erythema 
of the mucous membrane which is usually identical with the same 



ULCERS OF THROAT. 43 

eruption upon the skin. It is seen chiefly in the throat affecting 
principally the arches of the palate, tonsil, uvula, root of the tongue 
and pharynx ; occasionally, however, it is observed upon the vulva of 
women who have frequent sexual intercourse, and upon the glans 
penis of men with long prepuce. It is often so ephemeral and ill- 
defined as to entirely escape notice. When noticed it usually presents 
itself in the form of distinct patches, from one-eighth to three-fourths 
of an inch in diameter, the surface between the patches being healthy ; 
or the eruption may be widely diffused with well-defined borders. 
The color is red, sometimes copper-color, but there is really nothing 
distinctive about it. A deposit of lymph sometimes takes place, oc- 
curring in small aphthous-looking specks in patches of considerable 
size, firmly adherent and of a pale orange color. 

Erythema occurs six or eight weeks after the first appearance of 
the primary sore, although it may be present in a more or less modi- 
fied form throughout the entire disease. There is usually no great 
inconvenience arising from it, no soreness in the throat nor difficulty 
of swallowing ; but cases vary greatly, and in some instances there is 
pain, dryness, and considerable hoarseness. This affection usually 
denotes but a slight constitutional taint ; often disappears quite sud- 
denly, but is very apt to return. 

Ulcers of the throat are not uncommon, involving principally the 
posterior portion of the throat, the tonsils and the palate. 'The deep 
excavated ulcer, with a hard base, of circular or oval form, looks as 
if it had been cut out with a punch — it looks in fact like a Hunterian 
chancre. The surface likewise presents a similar appearance, being 
covered with a foul, greenish or yellowish lymph, giving it a dirty, 
unhealthy look. Its most frequent site is one or the other tonsil. 
The superficial ulcer corresponds in appearance and other respects, to 
the soft chancre, seldom existing alone, but being multiple, without 
induration, and possessing well-defined, ragged and undermined edges. 
Its surface is covered with whitish or yellowish, tenacious lymph. It 
is usually situated in the pharynx, on the uvula, or on the side of the 
throat or palate, and is accompanied with much swelling of the parts. 
Either of these ulcers may become phagedenic or gangrenous, and thus 
cause rapid and extensive destruction of the parts, difficulty of deglu- 
tition and permanent alteration of the voice. While febrile action is 
not common, it may accompany either form of ulcer ; and when the 
sore is located upon the tonsil, its most frequent site, the swelling 



44 MUCOUS PATCHES. 



may be so great as to greatly impede respiration. Small ulcers some- 
times form on the tongue, inside of cheek, etc., and if not accom- 
panied by the characteristic ulcer in other localities or other marks of 
syphilis, their diagnosis is a matter of considerable difficulty. The 
history of the case should be carefully considered, and abundant time 
taken before a positive diagnosis is declared. 

Mucous tubercles or patches, as they are usually termed, are 
found only in syphilis, and make their appearance early in the 
secondary stage, about the same time as roseola. They come on 
without much if any pain, occurring generally on mucous membranes, 
and in the neighborhood of outlets of mucous canals. They appear 
upon 4-he tonsils, tongue, lips, inside of cheeks, nose, pharynx and 
larynx, and also upon the body in the natural folds of the skin, where 
a constant state of warmth and moisture is maintained. So painless 
are they in the mouth, as a rule, that they are frequently first 
detected by the physician. The tonsils seem to be a favorite site, 
and ulceration is more apt to occur here, owing to the constant irrita- 
tion and frietioa from swallowing. In women, the most frequent 
site is the vulva; in men, the anus and mouth. Mucous patches 
consist of very slight elevations of the mucous membrane, of an oval 
or elliptical shape, of a dirty-whitish hue (only rarely red), and of 
the size of a pea up to that of a silver dollar, or even larger, when 
several patches run together. They do not seem to be painful, even 
when pressed firmly between the thumb and finger. When the 
patches are seated upon the skin, they consist of rounded disks, of a 
reddish or grayish color, and slightly elevated above the surrounding 
integument, and are then covered with an offensive muciform secretion, 
particularly if situated in the neighborhood of the genitals. These 
patches are then called condylomata. Relapses are very frequent. 
Mucous patches do not leave scars, unless they ulcerate, which they 
are very apt to do. Cleanliness will usually prevent ulceration. 

Allopathically, these affections are treated locally with Nitrate of 
silver. Acid nitrate of mercury and Nitric acid, with constitutional 
treatment according to circumstances. Homoeopathic treatment, how- 
ever, is vastly superior to this. The ulcers in the throat require the 
same remedies that would be indicated in ulcers occurring on the 
penis or elsewhere, and hence we need not repeat those indications 
here. For the gangrenous and phagedenic ulcers, the same is true. 
For mucous tubercles, there are no remedies equal to Thuja and 



TERTIARY SYPHILIS. 45 

Nitric acid, although in rare cases we may be obliged to resort to 
Calc, Puis., or Arg-nit. We invariably use, as a local wash, the 
third attenuation of the remedy administered internally. 

This finishes secondary syphilis, leaving the tertiary stage yet 
to be considered. 



TERTIARY SYPHILIS. 



Having briefly considered primary and secondary syphilis, it now 
remains to discuss the tertiary stage, affecting the skin, mucous mem- 
branes, periosteum, bones, fibro-cartilages, aponeuroses, tendons and 
testicles. It may be as well to state at this time that the dividing 
line between this, the tertiary stage, and secondary syphilis, cannot be 
accurately determined, as the latter runs gradually and insensibly into 
the former. It will be found also that some of the affections which 
we shall mention under this the last stage, do occasionally appear in 
the secondary stage. It is customary to designate those symptoms 
which appear before the sixth month as secondary, and those appear- 
ing at a later date as tertiary, but this is really too arbitrary a divis- 
ion, as we have already remarked ; it is preferable, as far as possible, to 
divide the disease into stages according to the tissue or parts affected. 

The syphilitic poison, we have already told you, may lie dormant 
m the system for a number of months or even years, and then break 
out, attacking and destroying with great rapidity various tissues and 
organs which seem to be its especial prey. Any part of the body 
may become involved, although the parts mentioned a moment ago 
are the most frequently attacked. The heart, lungs, liver, brain, kid- 
neys, etc., are not exempt from syphilitic disease, and, in bad cases, a 
fatal result is to be apprehended. It should be borne in mind, for it 
is a well-established fact, that occasionally the second stage is skipped 
entirely, the disease passing directly from the primary to the tertiary 
stage. It is also claimed, and we think truthfully, that this stage is 
not always preceded by bubo. 

The predisposing causes of tertiary syphilis are bad treatment of 
the former stages — intemperance, abuse of mercury, scrofula, bad hy- 
genic surroundings, debility, and impoverished state of the blood. The 



46 SYPHILIS OF THE BRAIX. 

inordinate use of mercury is, perhaps, the most important predispos- 
ing cause, and in such cases we have the worst possible form of syph- 
ilis to deal with ; we may say, in fact, that we have two distinct dis- 
eases to treat — syphilis and mercurialization. Tertiary symptoms 
follow both varieties of chancre, but more often the hard than the 
soft variety. The longer a soft chancre remains uninfluenced by 
treatment, the more apt it is to be followed by tertiary symptoms. 
The specific virus is destroyed in this stage, and hence the matter ob- 
tained from ulcers, abscesses and other sores is not inoculable. 

The diagnosis is comparatively easy when we take into considera- 
tion the history of the case, and a host of characteristic symptoms, 
more or less of which are always present. The main ones are, loss of 
appetite and strength, eruptions on the skin of a coppery color, ulcers 
in the throat, paleness of the face when free of eruptions, low spirited- 
ness and melancholy, nocturnal pains, fetid discharge from the nose, 
enlarged and indurated testicle and impotence. In addition to these 
symptoms, we also find various local affections which are readily dis- 
tinguished, and which we shall speak of presently. The important 
diagnostic points are the history of the case, and the existence of 
substernal tenderness, which it is claimed is present in the great ma- 
jority of cases of constitutional syphilis. 

The prognosis is always serious, for, at most, we can only promise 
a certain degree of relief, although cures do take place with some dis- 
figurement, as the loss of a nose or palate, extensive scars, etc. There 
is always some reminder of the disease left. 

"When secondary symptoms are light, or when tertiary symptoms 
come on very early, we fear syphilis of the brain and spinal cord, 
which, although of comparatively rare occurrence, is sometimes seen 
in hard drinkers, sedentary persons, and those who have had much 
mental anxiety or some previous nervous affection. Syphilis of the 
nervous system has received considerable attention and study the past 
five years, and although not perfectly understood, we are still in a po- 
sition to intelligently treat all such cases. Men are more prone to 
nervous affections than women, and are affected at any time from six 
months to twenty years after infection. The brain is more frequently 
affected than the spinal cord — in fact very little is known concerning 
syphilis of the cord. Paraplegia is, however, the leading symptom of 
the latter. 

Bumstead states that i; the nervous rjhenomena of syphilis gen- 



TERTIARY SYPHILIS. 47 

erally originates in lesions developed in one or more of the following 
structures: 1. The cranial bones and vertebra ; 2. The dura mater ; 
3. The arachnoid and pia mater ; 4. The brain and cord ; 5. The ar- 
teries ; 6. The nerves." These nervous phenomena may be due to 
(1) inflammation of the brain caused by the presence of nodes, caries, 
necrosis ; (2) to thickening of the dura mater, this membrane being 
peculiarly susceptible to the syphilitic influence ; (3) to congestion of 
the arachnoid and pia mater, with thickening of their membranes or 
gummatous infiltration ; (4) to red or white softening of the brain 
and cord ; (5) to interference with the circulation of the blood caused 
by thickening of the coats of the vessels and deposit of white blood 
corpuscles along their inner walls ; (6) to compression of the nerves 
by swellings, to neuritis or perineuritis, or alterations in the texture 
of the nerve. 

The symptoms of syphilis of the brain depend greatly on the lo- 
cality of the lesion. If situated in the cranial bones or meninges, in- 
tense, persistent headache with nightly aggravation, is a prominent 
symptom, but vertigo, sleeplessness, delirium and photophobia, are not 
unusual. This headache is frequently limited to one-half of the head, 
although it may shift its position. The symptoms are of a most 
varied character depending upon the amount of structure involved, 
and the degree of pressue upon the surface of the brain. Mental im- 
becility, epilepsy and paralysis, are caused when the arachnoid and pia 
mater become thickened and indurated or infiltrated with a gummy 
deposit. Coma, convulsions, paraplegia and hemiplegia are almost 
always the result of excessive doses of mercury. Very often the 
diagnosis can only be made by the process of exclusion and by the 
history of the case. The prognosis is not as grave as in other similar 
maladies, for it has been found that the gummy nodules found in the 
substance of the brain, the caries and necrosis of the skull-bones, and 
other evidences of disorganization, are wonderfully affected by reme- 
dial agents. For instance, Sil, Aurum, Nitric ac, Fluor-ac, Hepar, 
etc. 

Tertiary affections of the mouth and throat are very common. 
They manifest themselves as scaly patches due to epithelial thicken- 
ing, resembling icthyosis, but cannot be scraped off as they bleed 
readily on being touched, or as characteristic ulcers, which, if not 
arrested, gradually spread to the maxillary and palate bones, destroy- 
ing everything in their way, even the bones, so that the buccal and 



48 SYPHILIS OF THE INTESTINES. 

nasal cavities become one. In all such cases, the voice becomes 
greatly altered. Aurum, Sil, and Nit. ac. have served us best in such 
cases, as they have also in tertiary syphilis of the tongue. This 
form appears in a similar way in the shape of scaly patches, or as 
ulcers situated upon the sides of the tongue at or near its middle, 
and are of considerable extent and depth. The base of the ulcer 
h*is a hard feel like that of a chancre. The diagnosis is sometimes 
quite difficult unless the history of the case can be obtained. In 
some cases, it has been confounded with cancer. 

In a certain proportion of cases, the teeth become affected in 
tertiary syphilis, as is shown by the crown gradually separating from 
the fang. It is still an open question whether syphilitic erythema 
takes place in the intestines, but it is generally conceded that it 
does. At any rate, we are positive that ulcerations of a syphilitic 
character occur in a certain proportion of cases, affecting principally 
the colon and the small intestine, near the illeo-csecal valve. They 
may occur also in the stomach, and are manifested only by indiges- 
tion and pain in the epigastrium. The diagnosis of intestinal ulcer- 
ation can be made only by the existence of long-continued diarrhoea 
or dysentery, which does not yield to ordinary treatment, by the 
existence of well-marked syphilitic lesions elsewhere, and the history 
of the case. In one case which came under our observation, but not 
under our care, the dysentery resisted all treatment for a period of 
ten months, and death was the result. Excessive doses of mercury, 
we believe, is a predisposing cause of this complication, and Nitric 
Acid is our most valuable remedy, although often Merc. cor. high, 
acts well. Aloes in one case relieved greatly. 

Ulceration of the nasal mucous membrane may occur as a second- 
ary or tertiary manifestation, and even as a primary disease, the 
chancre sometimes appearing here fir^t. We shall, however, confine 
ourselves to the third stage, merely remarking in passing that sec- 
ondary ulcerations are recognized by the copious, bloody and puru- 
lent discharge, which is persistent. In tertiary ulcerations, or syph- 
ilitic ozaena, as it is frequently called, a very disgusting and offensive 
disease, there is a similar discharge, but it is very fetid. The voice 
is altered, becoming muffled and nasal. This variety is slow and 
insidious in its progress, involving eventually the cartilaginous and 
osseous structures, and the ulcerative process may perforate the sep- 
tum or the floor of the nasal cavity, or destroy the entire nose, 



TERTIARY SYPHILIS. 49 

unless soon arrested. The sense of smell is usually destroyed, and 
the taste somewhat impaired. Pain at night may or may not be 
present. When the cartilages are destroyed, the tip of the nose is 
flattened and depressed ; when necrosis of the nasal bones occurs, 
the tip is elevated. After a cure in these cases, the bridge of the 
nose is permanently sunken, giving a peculiar appearance to this 
important feature of the face. Aurum is by far the most important 
remedy in these cases, although Nitric acid, Sil, Hepar, and other 
remedies have been successfully employed. Nitric acid should be 
given if the patient has already taken mercury in large doses. 

The mucous membrane of the larynx is not unfrequently affected 
in the secondary and tertiary stage. In the former, as erythema, 
superficial ulceration, mucous patches and chronic inflammation with 
hypertrophy of the mucous membrane — in the latter as deep ulcera- 
tions, gummy tumors, perichondritis and necrosis. The tertiary 
lesions seem to be more common and occur from two to eight years 
after the primary sore. The symptoms of laryngeal syphilis are very 
deceptive and not in proportion to their gravity. A superficial ulcei 
may be complicated with oedema, threatening life on the one hand r 
and on the other the cartilages may be partially destroyed without 
the patient being aware of anything serious. It is unnecessary to 
here mention the secondary manifestations, as they are similar in 
appearance to those situated on other mucous membranes. Suffice it 
to say that the inflammation or ulceration pursues a very chronic 
course, and is quite difficult to cure. In the tertiary form, the vocal 
cords, the arytenoid cartilages, and the epiglottis become involved, 
and are finally destroyed by the ulcerative process. Frequently, 
instead of ulceration, the mucous membrane becomes covered with a 
number of gummy tumors of a red, fleshy appearance of the size of 
a mustard seed or small shot, and are usually most abundant about 
the vocal cords. These tumors often degenerate into deep, ragged 
ulcerations, which may eventually impede respiration and destroy life. 
The tracheal rings are sometimes necrosed and thrown off, and suffo- 
cation may result from oedema of the glottis, or even from the 
attendant ulceration. 

The symptoms present in syphilitic disease of the larynx are not 
uniform in degree ; pain may be entirely absent, or there may be 
painful and difficult deglutition, especially on swallowing fluids, at 
which times the patient may be threatened with suffocation. Pain 



50 SYPHILIS OF THE AIR PASSAGES. 

in the ear of the affected side is usually complained of. The voice 
may be hoarse and husky for months, and in time is either com- 
pletely lost or reduced to a mere whisper. Cough is always present 
to a greater or less extent, the expectoration being scanty, or copious, 
fetid, bloody, and sometimes mixed with fragments of cartilage or 
bone. The larynx is frequently tender on motion and pressure ; 
copious and exhausting sweats are not uncommon ; emaciation and 
debility follow in due course of time, and the patient may die of 
exhaustion, suffocation, or even hemorrhage from the ulceration of 
some one of the laryngeal arteries. 

The diagnosis is rarely attended with difficulty when we take 
into consideration the history of the case, the symptoms just enu- 
merated, and the presence of syphilis in other portions of the body. 
The prognosis should be guarded, as oedema of the glottis is a fre- 
quent and dangerous complication. The remedies best suited to this 
variety of syphilis are Lach., Carbo-veg., Ars., Sil. and Nit-ac. 

Syphilis affects the lungs but rarely, and usually presents itself 
in the form of gummy tumors, six or eight in number, of a dirty 
white or grayish color. These tumors resemble those of other organs. 
The symptoms of pulmonary syphilis are identical with those of 
chronic phthisis, viz.: night-sweats, cough, emaciation, shortness of 
breath, etc. The diagnosis would be impossible without a history 
of the case or the presence of other evidences of syphilis. Carbo- 
veg. was the only remedy we used in the case of a physician, and a 
complete cure was the result. The disease had lasted several months. 
Nit-ac, Hepar, Sil. and Sulph. have also proved valuable. 

The bronchial tubes are also sometimes the seat of syphilitic ul- 
cerations. The prognosis is unfavorable in all cases, for cicatrization 
of the ulcer leads to contraction and stricture, and the same is true 
of the air-passages generally. The remedies mentioned above may 
be given, and some relief will be experienced, if not a cure. 

Deafness may occur early in syphilis as a temporary ailment, but 
later in the disease it is apt to be permanent. It is sometimes pro- 
duced by syphilitic growth of the external meatus, at others by a 
mechanical obstruction of the pharyngeal openings of the Eustachian 
tube, by the remains of a soft palate becoming adherent to the pos- 
terior and lateral walls of the pharynx. Syphilis of the ear is of 
rare occurrence, about one-half of one per cent of all cases, and is 
not as weil understood, particularly when affecting the inner ear, as 



TERTIARY SYPHILIS. 51 

when affecting other organs of the body. It occurs, when not hered- 
itary, in intemperate persons, and makes its appearance in the form 
of sudden deafness, the result of catarrhal inflammation or other 
causes, accompanied with more or less pain, or at least a sense of 
fullness in the ear. Both ears are usually affected at the same time, 
but not invariably. This inflammation may result in ulceration and 
destruction of the tympanum, and consequent deafness, which is 
permanent. In bad cases, the Eustachian tube, the middle ear and 
even the bones, not only of the ear, but the petrous portion of the 
temporal, also, become involved. The diagnosis is based entirely on 
the history of the case, as there are absolutely no other diagnostic 
symptoms in most cases. 

Iritis is the most common, as well as the most serious affection 
of the eye developed in the course of syphilis. It is generally 
claimed that more than one-fourth of all cases of iritis are of syph- 
ilitic origin. It may be either acute or chronic, and occurs either 
as a secondary or tertiary manifestation after exposure to cold, even 
in strong and otherwise healthy people. It is usually associated 
with papular, tubercular or pustular eruptions, ulcerations of the 
mucous membranes, rupial sores or rheumatic pains in the bones. 
This affection will be recognized by a peculiar vascularity around the 
cornea and of the iris, by the fixed and contracted pupil and its dis- 
placement upward and inward. The iris is changed in color, and is 
covered with reddish-brown tubercles or minute yellow abscesses. 
Accompanying these changes is pain, either slight or severe, deep in 
the eye, forehead and temples, with nightly exacerbation. The disease 
is not limited to one eye, but almost invariably attacks both simul- 
taneously or successively. It sometimes see-saws from one to the 
other eye. The disease rapidly extends to the cornea, retina and 
other structures of the eye, and if not speedily arrested usually re- 
sults in impairment of or total loss of sight. Surgeons have laid 
down certain definite symptoms for rheumatic and syphilitic iritis, 
when in fact there are no certain means of distinguishing them, aside 
from the connection of the one with rheumatism and the other with 
syphilis. In rheumatic iritis often only one eye is affected, while in 
the syphilitic variety it is first one and then the other; the pain in 
the former is nearly constant, with slight aggravation at night ; in 
the latter the pain is variable, slight or very bad at night, but absent 
during the day. 



52 RUPIAL SORES. 



As regards the treatment of this serious complaint, mercury is 
recommended by both schools, and if the pupil does not dilate rap- 
idly, atropine to the eye. When tubercles or small warts appear on 
the iris Thuya may be used to advantage, although some physicians 
prefer Nitric acid, especially if the patient has had a thorough course 
of mercury. Cinnabar is valuable in scrofulous individuals. Hepar 
is necessary if pus forms. Aurum is indicated in advanced cases of 
tertiary, with a disposition to commit suicide. 

Ulcers of the skin or rupial sores (to which we have already brief- 
ly referred), maybe met with in the secondary stage, but usually they 
make their appearance late in the tertiary, and hence should be at 
least mentioned in this place. These ulcers are accompanied by nodes, 
rheumatic or bone^pains, or with ulceration of the throat, nose and 
larynx, or with all these ailments combined, and may result from pus- 
tules, tubercles or boils. At all events, they are usually preceded by 
papules, pustules, tubercles or scaly eruptions. These sores appear 
only in those with broken-down constitutions, and show intense syph- 
ilitic infection. They make their appearance most frequently on the 
extremities, or where the integument is thin, or where they are moist- 
ened by the secretion of the part, and occasionally on the scalp, fore- 
head and temples. They vary greatly in size, being as small as a 
split pea or as large as a cut melon, or even larger when several run 
together. Their shape is usually circular or oval, and they tend to 
spread in circles. The edges are callous, elevated and ragged, often 
everted ; the surface is covered with a foul grayish or greenish mat- 
ter, the discharge being thin, ichorous, offensive and often profuse. 
They are sometimes painful to the slightest touch, but not usually. 
The ulcers are generally superficial, the depth being about one-half 
the thickness of the integument, although they do in rare instances 
penetrate to the muscles and bones. Their duration is usually 
chronic when not influenced by medicines. They continue for some 
time ; at certain intervals creeping along slowly and eating deeply, at 
others healing, and again at others showing no appreciable change for 
days at a time. They may become phagedenic, grangrenous, etc., the 
same as the primary sore. 

Febrile action is not uncommon during their existence although 
it is slight. The patient complains of being tired and weak, has no 
ambition, no appetite *and an uneasy, unrefreshing sleep ; his bowels are 
costive ; his skin is dry and hot ; his pulse small and somewhat accel- 



TERTIARY SYPHILIS. 53 

erated ; his appearance is that of an old man ; frequently suicidal 
thoughts enter his mind. The scars left by the healing of the ulcers 
are at first brown or bluish and finally very white, puckered in the 
center. They are prone to re-open from the slightest irritation. 

The diagnosis is usually easily made, for the ulcers present a 
chancre-like appearance, with the copper-colored areola, and, in ad- 
dition, we find other evidences of syphilis present in the great major- 
ity of cases. 

As regards the treatment we shall mention Asa/, when the ulcers 
are very sensitive to the touch. 

Lachesis for bluish appearance of, and gangrenous ulcers. 

Arsen. for phagedenic ulcers. 

Sil. for penetrating ulcers, with thin, offensive discharge. 

Aurum for suicidal tendency. 

Nitric-acid, Jlercurius, Carbo-veg. Ars.-jod, and other remedies 
may be called for in special cases. 

The nails are sometimes attacked by syphilis. The various erup- 
tions we have described, may occur upon the fingers and involve the 
nutrition of the nails. Onychia or inflammation of the matrix is a 
common result in such cases, and the nails become dry and black and 
drop off, leaving an ulcer. Or there may be destruction of the nail 
without ulceration or without inflammation of the matrix — this, how- 
ever, is very rare. Not all of the nails of a hand or foot are attacked 
— usually not more than two or three altogether. There is no 
pain, as a rule, although the affection continues a long time. In 
exceptional cases, the pain is intense, and runs up the arm. If the 
disease is not speedily arrested, the matrix is apt to be completely 
destroyed, and the nail, of course, never forms again. When the 
matrix is not destroyed, the nail grows again, perhaps normally, but 
usually distorted in various ways. 

Tubercles, or gummata as they are termed, are liable to form 
where the sub-cutaneous cellular tissue is loose and abundant, during 
the progress of tertiary syphilis (rarely earlier than this stage), espe- 
cially in enfeebled persons or those of broken-down constitutions. 
Gummata are essentially syphilitic indurations of the connective 
tissue, varying in size from that of a pea to that of an orange, and in 
number from one to six. These tumors are of slow growth ; they 
are painless, but slightly tender to the touch ; they have a firm, semi- 
elastic feel, retaining their shape under firm pressure, and they are 



54 BONE AFFECTIONS. 

hardly ever situated near together, but are widely separated. When 
located just beneath the skin, they have a deep reddish-brown color 
previous to suppuration. They are movable at first for a period of 
several weeks or months, but gradually contract adhesions to the sur- 
rounding skin, and eventually suppurate and ulcerate if uninfluenced 
by internal treatment, discharging a honey-like or thick gummy mat- 
ter, with a slight admixture of bloody pus. After the discharge, a 
cavity, circumscribed by a cyst, remains, or an ulcer resembling a 
chancre, which may become phagedenic, gangrenous, etc., the same 
as the primary sore. 

As one crop of these tubercles disappears, it is usual for another 
to take its place, and thus the disease may be prolonged for a number 
of years. The tubercles consist of fibro-plastic matter, small nuclei 
and fatty granules, intermixed with amorphous substance. Quite 
frequently gummata form in the muscles and tendons, and in the 
viscera as well. Gummata of the muscles and viscera are usually 
preceded by disease of the bones, but not invariably. The diagnosis 
is easily made, as a rule. 

The treatment consists in building up the system, prohibiting 
alcoholic stimulants and administering such remedies as Ifepar, 
Nitric acid, Sil., etc. 

Lesions of the periosteum and bones are almost always preceded 
by a series of superficial secondary symptoms, and do not usually de- 
clare themselves until very late in the tertiary stage, that is from two 
to four or more years after the primary sore, although we may find 
bone pains previous to the cutaneous eruption, or may have nodes in 
secondary syphilis, but they are simply a sub-periosteal oedema and 
hyperaemia, and disappear promptly under treatment. Mauriac asserts 
that the bones may be affected even before the appearance of 
cutaneous eruptions ; but this opinion is not generally indorsed, ex- 
cept when the disease is hereditary. Affections of the osseous sys- 
tem are met with only in scrofulous or intemperate persons, or in 
those who have been actively treated with mercury. We thus see 
another form of syphilis which can often be laid at the door of this 
poisonous drug, notwithstanding many of our allopathic friends deny 
that mercury ever causes bone disease. Truly, the remedy is worse 
than the disease. Mercury administered even in small doses and 
continued for some time, deteriorates the system and renders it more 
prone to take on a low grade of inflammation, and this is particularly 
true of ifes action on the osseous system. 



TERTIARY SYPHILIS. 55 

The limit of lesions of the bones cannot be assigned — they are 
liable to last as long as the syphilitic diathesis continues. This form 
of tertiary occurs as nodes or soft tumors, inflammatory hypertrophy, 
exostosis, caries and necrosis. The bones usually affected are the 
superficial ones, as the tibia, fibula, ulna, clavicle, palate, nose, upper 
jaw and the bones of the skull, although in exceptional cases almost 
every bone in the body becomes affected. 

A node is a gummy formation, and may be defined as an inflam- 
matory osteo-periostitis, terminating usually in a new formation of 
bone. Nodes occur generally on the tibia, ulnar, clavicle and skull. 
They are of a rounded or elongated shape, semi-solid, elastic and 
somewhat painful to the touch, and from a quarter of an inch to two 
inches in diameter. They begin beneath the periosteum upon the 
surface of the bone, to which they are attached, as an inflammation, 
followed in a few days by the deposition of a gummy substance of a 
greenish hue, often mixed with pus, or the gummy substance may be 
entirely wanting, and the tumor composed entirely of pus. This 
tumor should never be opened, as it may undergo resolution at any 
time under appropriate treatment. Even in cases where it seemed 
on the point of bursting through the thinned skin, this has hap- 
pened. Not only the periosteum, but the bone, likewise, is inflamed, 
softened and ulcerated, and, as the tumor grows, it involves the struct- 
ures above, which become reddened and painful. If opened artifi- 
cially or otherwise, the discharge consists of a gummy substance 
mixed with pus, or of pus alone. 

A node is really an abscess of the fibrous and osseous tissues. Its 
course is always indolent, and the pain which accompanies it is of a 
neuralgic character, greatly aggravated at night. This pain in most 
cases is only present at night, and seems to be occasioned by the heat 
of the bed, for if the patient from any cause fails to go to bed and re- 
mains up all night, the pain does not come on. After a node 
ulcerates, it shows but slight tendency to extend, but it may become 
gangrenous, phagedenic, indolent, etc.; in other words, it may take 
on any kind of action common to syphilis. Sometimes a node will 
remain as a hard, fibrous swelling, perfectly painless, for a number of 
years, causing the patient but slight inconvenience, but at any time it 
may suddenly soften and involve the bone in destruction. After a 
node ulcerates, the floor is bone denuded of its periosteum, which 
soon becomes black, and necrosis occurs. Scars are always left to tell 



56 CARIES AND NECROSIS. 

the tale, and they are white, puckered, attached to the bone, and 
often pigmented at the circumference. 

The diagnosis is not difficult, as the appearance of the swelling, 
the course of its growth and the nocturnal pains are characteristic. 
The treatment consists in the use of one of the following remedies : 

Asa/., nodes very sensitive to the slightest touch. 

Nitric acid, or Kali-jod., after the abuse of mercury. 

Hepar or Sil., during the suppurative stage. 

Ars., Lack., Carbo-veg., for phagedena or gangrene. 

Mezer., Staph., Phos-ac, for intense pains in the periosteum. 

Fluor acid, burning, intermittent pains in the bones. 

Caust., excessive physical depression and loss of strength. 

Plumb., Plat., Phos., Puis., Petr., Sulph., Lye, Natr-ra. and 
Ars. should also be carefully studied. 

Dry caries, which is characterized by the entire absence of sup- 
puration, occurs late in syphilis, and is recognized by intense localized 
pain without swelling. The parts affected are the flat bones, as the 
frontal and parietal, sometimes one table only and at others both. It 
is caused by gummy deposits in the outer sheaths of the vascular 
supply, or by a cutting-off of the nutrition of the part by an inflam- 
mation and degeneration of the vascular periosteum. The disease 
occurs only in those of advanced age. Caries, or ulceration of the 
bone, affects principally the tibia, ulna, palate, maxillary, turbinated 
and ethmoid bones, and presents itself in different forms, viz.: As the 
simple ulcer, serpiginous ulcer, or as worm-eating caries. It is denied 
that caries is strictly syphilitic, but is due entirely to a development of 
the scrofulous diathesis. Caries is usually conjoined with necrosis, 
although it may exist alone. In some cases, as we have already re- 
marked, the mouth and nose communicate, the intervening structures 
being totally destroyed. 

Necrosis or death of the bone usually follows caries, especially in 
the thin bones of the nose, palate, etc., but it also occurs in the cranial 
and jaw bones in very many cases. 

Hypertrophy, or hyperostosis, may implicate any portion of the 
osseous system, although it usually affects the superficial and long 
bones. It is occasioned by the deposition of gummy tubercles in the 
medullary canal, and in the substance of the bone itself. The sur- 
rounding tissues exhibit no sign of inflammation, but the part 
affected becomes greatly enlarged, a solid osseous substance is substi- 



TERTIARY SYPHILIS. 57 



tuted for the spongy matter, the medullary canal is obliterated and 
the bone becomes similar to ivory in texture. The symptoms pres- 
ent are few in number, viz.: The characteristic nocturnal pains and 
neuralgic pains of varying intensity at all times in the muscles and 
tissues in intimate connection with the diseased part, with an in- 
creased feeling of weight in the limb. 

An exostosis originates in a plastic periostitis, and is the same 
thing, but usually does not affect but a small portion of the bone, 
the tumor being of variable size, knotty and irregular with a broad 
base. The tumor or tumors may at first be movable upon the bone 
beneath, but after a time, if resolution does not occur, becomes at- 
tached and a part of it. When an exostosis springs from the inner 
surface of one of the cranial bones, it gives rise to very serious symp- 
toms, terminating frequently in convulsions and paralysis. In deep- 
seated regions where direct exploration cannot be made, exostosis can 
only be suspected from the history of the case. When the tumor be- 
comes eburnated, no internal treatment is of avail, and surgical in- 
terference may be necessary. 

The cartilages are sometimes attacked by gummy infiltration as 
well as the bones, particularly the cartilages of the larynx, and 
necrosis may be the result. We have already spoken of this. 

Mercurius is recommended for exostosis, but as patients thus 
afflicted have usually taken large doses of mercury, we find Nitric 
acid a more useful remedy for this as well as for other bone 
affections. 

Aurum is valuable when the bones of the face, nose or skull are 
affected. Suicidal tendency. 

Sil.j Kali-jod., in scrofulous persons. Ulceration of the bones 
with fistulous openings ; inflammation of the periosteum. 

Fluor-acid, burning and intermittent pains in the bones. Im- 
aginary fears ; ill-humored. 

Phos-ac, intense pains in the periosteum of all the bones as if 
scraped with a knife ; low-spiritedness. 

Asa/., violent pain in the bones, and discharge of fetid, thin, 
ichorous pus ; crampy jerking and drawing in the bones at night. 

Hepar, swelling or inflammation of the bones. 

Mezer., tearing and burning pains in the bones; dark, turbid 
urine. 

Petr., brown spots on the wrists ; skin ulcerates easily ; fetid urine. 



58 SYPHILIS OF THE JOINTS. 

Rhus. Rheumatic pains aggravated on first moving after rest and 
on getting up in the morning. Worse during rest, better from con- 
tinued motion ; paralysis of lower limbs ; warts on various parts of 
the body. 

Staph., caries, particularly of the teeth; pressive pains in the 
periosteum ; confusion of the intellect. 

The joints are occasionally involved in both secondary and tertiary 
syphilis. Specific inflammation may attack the articulations at the 
outset, or by the extension of an osteitis from the articular extremity 
of the bone. It occurs in weak, ill-fed and ill-clothed persons. In 
secondary syphilis, synovitis is attended by pain, fever, sweat, etc., 
much resembling in its general symptoms acute articular rheuma- 
tism, but the affection begins slowly and painlessly. There is always 
effusion into the joint, but there is an intermittent character to this 
effusion, the fluid sometimes appearing and disappearing rapidly, to 
again re-appear, or it may make its appearance slowly and as slowly 
go away ; but in either event, it is very prone to re-appear from very 
slight causes. There is no tendency to suppuration or to destruction 
of the joint. The synovitis of the tertiary stage, however, is attended 
with lesions % of the joint structures. The synovial membrane becomes 
thickened and incrusted with gummy matter, while its cavity contains 
a turbid, viscid fluid. Stiffness of the joint and of the surrounding 
muscles and structures is complained of, especially on motion in the 
morning. The pains are usually worse at night and in wet weather. 
The character of the pain is dull and aching, seldom tearing or burn- 
ing. Aside from the deposit in the synovial membrane, there is 
usually a gummy infiltration in the muscles and other structures 
about the joint. The knee, elbow and wrist joints are the parts most 
liable to be attacked, although in rare cases hardly any joint is 
exempt. 

The disease may remain stationary for years. There is but slight 
tendency to complete anchylosis. Unless the syphilitic antecedents 
of a white swelling are known, the diagnosis is impossible, although 
we know that its onset is insidious, and that it pursues an indolent 
course. 

The urinary organs are not entirely exempt from the ravages of 
syphilis, but as yet the lesions are not very well understood, and their 
diagnosis is often a matter of considerable difficulty. Gummata are 
rarely met with in the kidney, but when found they seldom exceed 



TERTIARY SYPHILIS. 59 

the size of a pea. Deposits in the kidney are always associated with 
similar deposits in the liver and spleen. As a rule, there is no local 
pain or general fever, and the existence of the disease is surmised 
only by the presence of albumen in the urine and the history of the 
case. It should be remembered, however, that the urine is not al- 
ways albuminous, and the diagnosis cannot be made, except by a 
post mortem examination. 

Syphilis of the ureter and prostate does not seem to occur, neither 
dotes syphilis of the bladder, except in connection with disease of the 
spinal cord. The spermatic cord is sometimes the seat of gummy 
deposits. 

Grummata occur in the corpora spongiosum, and in the corpora 
covernosa in very rare cases as a hard, painless nodule without red- 
ness. It has a semi-elastic feel when pressed between the fingers. If 
seated on one side, it causes deflection of the penis when erect toward 
that side ; but if it assume the annular form, the penis, during 
erection, is turged from the crura to the seat of the lesion, but beyond 
that is flaccid and hangs at right angles to the rest of the organ. The 
tumor reaches a certain size, and then may soften and shrivel away, 
or possibly may become fibrous. 

Syphilis of the testicle, known under the name of syphilitic 
sarcocele, orchitis or albuginitis, makes its appearance from two to 
fifteen years after the primary sore, and is usually accompanied by 
some form of tertiary, as periostitis, exostosis, ozaena, or ulcers in the 
throat, although in rare instances it is the only manifestation of 
syphilis present. It always denotes a low state of the system. Ex- 
ceptionally, in malignant cases, orchitis may be developed in a very 
few months. The exciting cause of this form of syphilis may be a 
blow or other injury of the parts. The disease generally involves 
both testicles, either at the same time, or first one and then the other 
at variable intervals. In some cases, the scrotum remains healthy 
and non-adherent, in others the disease eventually extends to the 
epididymus, forming one inseparable mass of the two structures. 
Usually there is an entire absence of pain and an insensibility to 
pressure. To the touch, the testicle resembles a stone or block of 
wood, with slight knobby projections. Toward night the testicles feel 
very heavy, and if left hanging unsupported, occasion a dragging 
sensation in the spermatic cord, but there is no real nocturnal exacer- 
bation as in bone disease. There is usually a slight aching pain in 



60 IMPOTENCE. OVARITIS. 



the small of the back. The testicles not only become heavier and 
harder, but are greatly enlarged, sometimes becoming three times 
their natural size. The surface of the tumor, which preserves the 
normal shape of the testicle, is usually smooth, only rarely knobby. 
In advanced cases, the spermatic cord becomes involved, and is hard- 
ened and thickened. In malignant cases, fortunately very rare, 
tubercular deposits occur, which terminate in the formation of ulcers 
and in the production of fungi. The course of orchitis is exceed- 
ingly slow and chronic. The sexual desire is greatly diminished, or 
entirely lost. Orchitis is of occasional occurrence in inherited syph- 
ilis. The affection terminates in resolution or in fibrous atrophy, 
and, as we have already stated, in ulceration in bad cases. Early 
and persistent treatment will restore the parts to their normal 
condition. 

The testicle has frequently been amputated, under the supposi- 
tion that the affection was of a cancerous nature. In cancer, pain is 
a prominent feature, but not in orchitis. The diagnostic points are 
absence of pain, insensibility to pressure and a syphilitic history. As 
regards treatment, we have found Conium of very great service — in 
fact, it is the most important remedy. Clem., Puis., Nit-ac. and Lye. 
are also useful. Hepar, in cases with ulceration. The remedy 
should be chosen according to the totality of the symptoms. 

Impotence, as we have shown, is sometimes due to orchitis, but in 
other cases it may come on independently of any cachexia, or may be 
due to some impression upon the nervous system. 

Syphilitic ovaritis is not uncommon, and is apt to be associated 
with gummy tumors in the breast. The only symptom is painless 
swelling of the organ. 

The rectum is frequently involved in syphilis, either through 
chancres situated near the margin of the anus, or through secondary 
or tertiary ulcerations within the gut. In either event, stricture of 
the rectum is usually the result. The patient complains of a great 
desire to go to stool, with pain iD the rectum, attended by an exces- 
sive discharge of pus and bloody feces. Constipation is rare, and is 
present only at the commencement of the ulceration, or in very 
exceptional cases. As a result of this constant loss of blood, the 
patient becomes weak, loses flesh and suffers from gastric difficulties. 
We have never seen these rectal ulcerations in men, and hence infer 
that they are much more common in women. The stricture when 



HEREDITARY SYPHILIS. 61 

present yields to the influence of properly selected remedies, such as 
Nitric acid, Phos. acid., Caust., Hepar. 

Syphilis attacks the liver more frequently than any other of the 
viscera ; in secondary, in the form of congestion, with icterus ; in 
tertiary, as chronic interstitial hepatitis, as gummata, or as amyloid 
degeneration. The symptoms of chronic hepatitis are those of ordi- 
nary cirrhosis. The diagnosis of gummata is very difficult, and 
often impossible. Pain, if present, does not extend to the shoulder 
as in other affections of the liver. Blood may be expectorated and 
passed with the clay-colored stools ; epistaxis is not uncommon ; 
icterus is present in a certain proportion of cases ; the skin is dry and 
cool. The symptoms of amyloid degeneration resemble those of cir- 
rhosis. Treatment promises but little, except in gummata of the liver, 
when such anti-syphilitic remedies as we have frequently mentioned 
may be administered. 



HEREDITARY SYPHILIS. 



The terms congenital and infantile have been used, and are still 
used, to designate this form of syphilis. The term congenital should 
be employed only where a child is infected during labor ; and as the 
term infantile means simply syphilis of children, it is better and more 
accurate to call this division of our subject hereditary syphilis. Hun- 
ter denied the inheritance of syphilis, but at the present day his 
opinion is not accepted. It is true that we are still ignorant of the 
-amount and nature of the constitutional affection of the parents, that 
is necessary for the development of syphilis in their children ; but we 
are not ignorant of the fact that it is possible for syphilis to be trans- 
mitted by inheritance. There is a vast difference of opinion as 
regards the etiology of this form of syphilis, and we can in this 
lecture give you only a brief summary. 

Arbitrary rules regarding the parental influence in the transmis- 
sion of syphilis unfortunately cannot be laid down, and, as a matter 
of fact, there are two sides to almost every question which we shall 
discuss. We are certainly not warranted in concluding from our 
present knowledge, that a parent who has been, or even who is 



62 PATERNAL AND MATERNAL INFECTION 

suffering, from constitutional symptoms, will necessarily procreate a 
syphilitic child. The vexed question, and one which seems as far 
from solution as ever, is, Does the child derive its disease solely 
from the father, the mother being healthy ? 

Some authorities assert, and others deny, that the father can 
communicate the disease to the offspring. Cases are reported, show- 
ing : 1st. A syphilitic father, and a healthy child. 2d. A syphilitic 
mother and a healthy child, and even, 3d. Both parents syphilitic, 
and still a healthy child. It may be stated, as a general rule, how- 
ever, that when both parents are syphilitic, the child will be affected. 
And this rule usually holds good, even after the disease has become 
latent in the parents, that is, even after they seem to have entirely 
recovered. In course of time, syphilis wears itself out, or is relieved 
by treatment, and the offspring escape infection. Parents suffering 
from active syphilis are not able to raise the child — it dies in a few 
weeks or months — or more often still, the foetus fails to reach maturity. 
A child born of parents in whom the disease is on the wane, or 
greatly modified by treatment, shows usually but slight evidences of 
the malady, and it is stated and believed by many authorities that 
after six years the risk of transmission is extremely slight. 

It is a fact known to all who have thoroughly investigated the 
subject, that there are certain periods of repose in this affection — of 
longer or shorter duration — and during these intervals it is possible 
that healthy children may be born. For instance — the first, third 
and fifth child may be healthy — whereas the second and fourth may 
be diseased. In other words, it may be said that when there is no 
venereal manifestation, the child procreated runs but slight risk of 
being infected. But arbitrary rules cannot be laid down, and the 
statement, while it may be true as regards the father, i3 not as certain 
as regards the mother, who may bear syphilitic children at any time 
and under all circumstances. There are so many peculiarities about 
the transmission of syphilis by inheritance, that one can hardly make 
any statement that cannot be proved or disproved by numberless 
cases. Syphilis tends to exhaust itself, and, as a general rule, the 
children become less and less diseased as time goes on — that is with 
syphilis — but scrofula may take its place. 

There can be no possible doubt that when the mother alone is 
syphilitic, the child is quite certain to inherit the disease, except 
during the intervals of repose, already referred to. The ovum being 



HEREDITARY SYPHILIS. 65 

a part of the mother, whose fluids are poisoned, it is almost a matter 
of necessity that it should develop into an unhealthy child. Syphilis, 
it should be remembered, while occasionally a mild disease in women, 
generally affects them more profoundly than men. Hence, there are 
numerous exceptions, owing to this occasional mildness, and to the 
intervals of repose, and a syphilitic mother may bring forth a healthy 
child. Cullerier, Notta, Adam Owre, Sturgis, J. W. Thompson, 
Mireur, Follin, Charrier and others contend that syphilis is always 
inherited from the mother alone. A peculiar fact, if fact it is, difficult 
of explanation, is, that a perfectly healthy woman having a syphilitic 
husband, and bearing syphilitic children, should, upon a subsequent 
marriage to a perfectly healthy man, continue, for a time at least, to 
bear syphilitic children. It is impossible to account for it, except 
upon the supposition that the semen makes a permanent impression 
upon the ovaries, or that the disease is masked in the woman. 

When the father alone is syphilitic, the child usually escapes if the 
mother remains well. Nearly all authorities admit that the father is 
less liable to transmit syphilis to his child than the mother ; but very 
few deny that he does exceptionally transmit it. Caspary, Keyfel, 
Van Harlinger, Trousseau, Mayer, Kassowitz, Bumstead and others 
ascribe equal if not more power to the father than to the mother in 
transmitting the disease. They believe in the main that the father 
alone — the mother being sound — may be the cause of syphilitic 
offspring, and that the mother, if healthy at the time of conception, 
may remain so. Every practitioner knows of scores of cases, if he 
has paid especial attention to syphilis, where a diseased father and a 
sound mother have given birth to perfectly healthy children ; but he 
does not remember more than one, or possibly, two cases, where a 
sound father and a syphilitic mother produced healthy children. 
When we look at the vast number of young men, who are, or have 
been affected with syphilis, the rarity of diseased children is surprising, 
if we adopt the theory of transmission from the father. And yet we 
have evidence sufficient to prove that exceptionally the father is the 
cause of the syphilitic child. 

It is a well-known fact that in the higher walks of life, syphilitic 
children are a rarity, and yet comparatively few young men of this 
class escape contagion. In the lower walks of life, the women are 
not so virtuous, and syphilitic children are quite common, hence 
adding weight to the opinion that syphilis is derived entirely from 



■64 SYPHILIS IX PREGNANCY. 



the mother. Henock observed the birth of a syphilitic child twenty 
years after the infection of the mother. 

It has never been conclusively shown that a healthy mother who 
had given birth to a syphilitic child, diseased from its father, after- 
ward became herself poisoned by experimental or accidental inocu- 
lation. Colles states that a child with inherited disease may poison 
a healthy stranger whom it suckles by inoculating the breast, but that 
the same child never locally infects its mother. If we accept this 
statement, we are obliged to conclude that the mother is already af- 
fected. He also holds the opinion that the disease may be communi- 
cated to the nurse by mere contact without the presence of an abra- 
sion or crack upon the nipple. We have seen one instance of this 
where the most careful scrutiny failed to discover any abrasion, and 
yet the diseased child communicated syphilis to the nurse, in this in- 
stance its aunt. Caspary found a seemingly healthy woman with a 
syphilitic husband and a syphilitic child, and he inoculated the wo- 
man with the specific virus without effect. Thus the woman, al- 
though apparently healthy, probably had a mild form of syphilis. 
We say probably, because inoculation does not always succeed any 
more than vaccination does. 

The date at which a pregnant woman may become syphilitic with- 
out poisoning her child is after the seventh month. If she gets chan- 
cre at the moment of conception, or soon after, she is apt to miscarry. 
If she gets it later, the child goes to term, but is born thoroughly 
poisoned, with a poor chance of surviving. The common agreement 
is that if the chancre does not appear before the seventh month, the 
child is safe, but there are numerous exceptions. Bumstead takes 
the ground that the syphilitic virus of the mother cannot be conveyed 
through her blood to the child, for the reason that the essential ve- 
hicles of the specific virus are cells or albuminoid molecules, derived 
from an active syphilitic lesion, and the embryo is not supplied with 
cells of any kind after fecundation. So that a syphilitic child, born 
at full term of a mother infected at some time during gestation, is 
poisoned by the father. For the same reason, he contends that a 
healthy mother can bear a syphilitic child, the immunity of the mother 
depending on the absence of cellular elements in the fluid inter- 
changed. 

Ricord speaks of this mode of infection, and calls it choc-en-retour. 
He contends that a healthy woman may conceive by a syphilitic man, 



HEREDITARY SYPHILIS. 65 

and the ovum become diseased through impregnation with diseased 
semen, and in its turn poison the mother, the latter never undergo- 
ing chancre, but becoming directly contaminated by contact of her 
fluids with the infected fluids of the fetus, thus giving the mother 
a modified form of the disease. The semen nowadays is not sup- 
posed to contain the specific virus, but we do not believe a great many 
cases could be explained if we deny that it is ever the source of con- 
tagion. 

The transmission of syphilis to the third generation has been 
generally doubted. Most authorities believe that after it has been 
once transmitted by inheritance, it degenerates into scrofula, which, 
in its turn, may be transmitted. The probable reason that cases are 
not met with is that children either die before maturity or get far into 
the tertiary stage before they are old enough to marry. One 
would think that this subject could be definitely settled with such a 
mass of cases constantly presenting themselves, but the difficulty is 
to ascertain all the facts, particularly in cases occurring in families 
of good social position. Men and women both will deny little pec- 
cadillos that would throw much light on the subject. 

As regards the mortality of syphilitic children, it is given as fully 
thirty-five per cent. Abortion, the result of the death of the foetus, 
takes place before the seventh month, as the result of infection ot 
the mother during pregnancy between the first and seventh months. 
The foetus thrown off has a livid, purple color ; the skin shows noth- 
ing characteristic, but is easily detached. The viscera show syphilitic 
lesions. 

As regards the frequency of abortion, we quote the following 
from Dr. H. C. Jessen's monograph on " Hereditary Syphilis : " 

\ For the most careful analysis hitherto made of the fate of the 
offspring of syphilitic marriages, with reference to the frequency of 
abortion, the number of viable children, etc., we have again to thank 
Kassowitz. His statistics include 330 births occurring in 119 mar- 
riages under the influence of syphilis of the father, the mother or 
of both parents. 

" Of these 330 children, 127, or 67 per cent, were born prema- 
turely, and of these 127 births 31 were abortions, properly so-called. 
Again, of these 127 births, 80 per cent occurred when the mother 
and 32 per cent when the father alone was syphilitic. Further, of 
these 127 children 102 were still-born ; 11 died in the course of the 



66 THE SYPHILITIC CHILD. 

first day ; 7 in the course of the first week ; 4 before the end of the 
first month, and but three survived. 

11 Of these 330 children, only 203 were carried to full term ; of 
these again 9 were still-born, so that of 330 children of syphilitic 
parents 111, or about every third child, was still-born. Of the 
remaining 219, 80 died within six months, so that only 139 lived 
beyond childhood. If we now assume that all of these premature 
deaths were due to syphilis, which is not quite justified, then of 330 
children only 191, or about 58 per cent, are carried off from the 
parental infection. 

" These statistics, which are not from a hospital, but from the 
private practice of a single observer in the lapse of ten years, may 
give us some idea of the enormous number of children which are 
sacrificed every year to hereditary syphilis." 

It is usually stated that the syphilitic child born at full term is 
thin and wrinkled. This is not always true. As a rule, they appear 
well nourished and perfectly healthy, but before many days or weeks 
evidences of disease show themselves. The severity of the malady 
is in proportion to its activity in either or each parent at the time of 
conception. The time of its appearance after the birth seems to 
depeDd upon its severity. Its early appearance indicates a very ma- 
lignant type. 

The prognosis is always grave in children born with manifest? 
tions of the disease, such as pemphigus or large bullae scattered over 
the body, filled with serum and blood. The longer, however, the 
syphilitic dyscrasia is in making its appearance, the more favorable 
the prognosis. 

Among the first indications seen in a child born apparently healthy 
are (about the sixth week) loss of appetite — the baby nurses badly, 
has restless sleep, its bowels are more or less disturbed and it has the 
snuffles. There is a difference of opinion as regards this snuffling, 
some attributing it simply to a congested condition of the nose with 
affection of the mucous membrane, and others to disease of the nasal 
bones. Some authorities go so far as to say that it is never present 
as a syphilitic manifestation unless the bones are implicated. The 
discharge may be offensive or crusts may form, seriously impeding 
the respiration of the child. 

Emaciation commences as a result of the loss of the appetite 
and is usually progressive until the child is a mere skeleton, but in 



HEREDITARY SYPHILIS. 67 

exceptional cases the diminution in weight is not noticeable. The 
skin of the face becomes discolored and is drawn tight over the bones. 
The eyes become very prominent — seldom sunken. The voice be- 
comes hoarse, feeble and moaning from the implication of the larynx. 
The breathing is accompanied by a slight rattling and is performed 
through the mouth. Mucous tubercles soon make their appearance 
about the anus and in a short time on the genital organs and in the 
folds of the skin, irritated by the urine and feces. On examining 
the chest and abdomen roseola will usually be found, after the sixth 
week, either preceding or accompanying the coryza. The early 
change of color from a bright red to a coppery hue is an important 
diagnostic feature. In place of roseola we may find small and large 
flat papules, at first dull red and afterward coppery, scattered over 
the body, similar to the same affection in adults. The pustular 
syphilide appears about the eighth week and is found more abundant 
on the thighs, buttocks and face, although invading the entire body. 
It is sometimes associated with the vesicular syphilide. 

Pemphigus is sometimes seen at birth, but more often when the 
child is from one to six weeks old, and is situated mainly on the 
palms of the hands and soles of the feet. Glummata and gumma- 
tous ulcers may appear as early as the third year, but generally not 
until the tenth or twelfth. The viscera are affected at varying 
periods, from a few months to several years, the liver almost uni- 
formly being the organ first implicated. Affections of the osseous, 
fibrous and cellular tissues are usually late in making their appear- 
ance, but exceptionally are very early. The temporary teeth are 
cut unusually early, are of a very bad color and soon crumble away. 
The child may possibly survive under good treatment until second 
dentition when the teeth, especially the upper central incisors, pre- 
sent certain characteristics, diagnostic of hereditary syphilis, and first 
described by Mr. Jonathan Hutchinson. The upper central incisors 
when first cut are unusually short, narrow from side to side at their 
edges and very thin. After a time a crescentic portion from their 
edge breaks away, leaving a broad, shallow, vertical notch, which is 
prominent for some years. The two teeth often converge and some- 
times they stand widely apart. When this notching is not present or 
but slightly marked, there is still a dirty brownish color of the teeth 
and a narrow squareness of form. 

Keratitis is seen in children of from five to fifteen years of age. 



€8 TREATMENT. 



The opacity commences in the center of the cornea and gradually in- 
creases until the greater part of the cornea is involved, giving to the 
whole structure the appearance of ground glass. It is followed by 
vascularization, not confined to the surface, but invading the whole 
thickness of the cornea, without any tendency to ulceration. Both 
eyes are usually affected, first one and then the other. 

The treatment of hereditary syphilis varies according to the 
symptoms present in any given case. Nitric Acid we have found 
one of the best remedies, particularly for ulceration of the uvula, 
pharynx and fauces ; vesicles on the tongue and inside of the 
cheeks ; swelling and phimosis of the prepuce ; old ulcers on the 
body. All cases where much mercury has been taken by the par- 
ents. Ulcerations of mucous membranes ; affections of the perios- 
teum and bones ; hemorrhages ; yellowness of the skin with consti- 
pation ; oppressed breathing. 

Arsen. for pemphigus, ulcerations, suppurations; great exhaustion ; 
marasmus ; skin dry, shriveled ; coldness and chilliness of the body ; 
eruptions discharging a thin, acrid, burning ichor ; excoriating dis- 
charge from the nose ; restless sleep ; cold, clammy sweats ; black 
vesicles, or black eruption; complexion white and pasty-looking; 
pulse weak and fluttering ; catarrh threatening suffocation at night. 

Aurum — Disease of the nasal or cranial bones, with ozaena, 
scrofulous children ; eyes prominent ; redness of the sclerotica ; 
swelling of the parotid gland ; swelling of the testicles ; roseola. 

Asa/. — Caries and ozaena. Child cries when dressing the sores, 
or even when preparing dressings ; irritable ; distention of the stom- 
ach and bowels ; colicky pains ; stools brown and offensive ; swelling 
of the female genitals ; coldness of the hands with blue nails, and 
heat of the face. 

Calc. carb. — Thin, pale face, with dark circles around the eyes; 
whitish stools ; great debility ; painless glandular swellings ; offensive 
smell from the teeth ; swelling of the tonsils ; milk does not agree ; 
sour vomiting; very frequent urination ; unhealthy ulcerating skin ; 
profuse sweat of the head. 

Carbo veg. — Child peevish, restless ; skin blue and cold ; urine 

dark and red with red sediment ; hoarse, rough voice ; oozing from 

the anus at night of a musty mucus ; bleeding of the gums and nose. 

Hepar. — Suppuration of indurated glands; pustular eruptions; 

ulceration of the throat ; fetid breath : voice hoarse and husky ; fall- 



HEREDITARY SYPHILIS. 69 

ing out of the hair ; scurvy eruptions ; burning urine, excoriating 
the parts ; iritis ; soreness and moisture in the fold between the scro- 
tum and thigh, and about the anus ; agglutination of the eyes at 
night ; the nasal mucus is bloody. 

Staph. — Caries of the teeth ; ostitis and periostitis ; restless 
sleep ; very nervous, starting at the least noise. 

Merc. — Affections of the mucous membrane, the skin and the 
glandular structures ; greenish stools ; turbid urine ; loss of appetite 
pale, bloated or sallow face; emaciation; nose pointed; breath offens- 
ive ; the gums recede from the teeth ; keratitis ; copper colored 
eruptions on the body. 

Oinnabaris, when mercury, although indicated, seems to be of no 
benefit. Ulcers with hard, raised, indolent edges ; ulceration about 
the anus ; swollen glands. 

Fluoric Acid. — Softening, swelling and curvature of f he bones ; 
painful ulcers in the mouth ; offensive urine ; sour, offensive perspi- 
ration. 

Benzoic Acid. — Copious, watery, but very fetid diarrhoea ; stools 
watery, white ; urine deep red, and very offensive ; copper-colored 
eruption on the fingers ; copious perspiration at night. 

China. — Excessive weakness ; one eye open and the other closed 
during sleep. 

Tartar Emetic. — Pustular eruptions on the thighs and scrotum; 
swelling of the inguinal or cervical glands ; slimy, watery, yellowish 
stools ; rattling breathing ; ulceration of the mouth and tongue. 

Argent, nitras, Sepia, Silic, Phos., Phos. ac, Kali, jod., 
Kali hyd., Sulph., Lach., Lye, Thuja and other remedies may be 
called for, and have proved valuable The symptoms should be 
carefully studied in every case, as it is only by the most skillful 
treatment that hereditary syphilis can be cured. 



G-ONORRHCEA. 



Various names have been applied to this disease of the mucous 
membranes of the genital organs and eye, at different times and 
places. The American and English writers uniformly use the term, 
gonorrhoea; the French, the words, blenorrhagia, or " chaude-pisse" 
the latter being the popular name for clap. 

The disease is a very ancient one, and numerous references to it 
can be found in the Bible. See Leviticus, xv, 2-13. It is also, by 
far, the most frequent affection originating in sexual intercourse, and 
is much more common in males than females. The causes are inter- 
course with a person similarly affected, or with one suffering from 
leucorrhcea, menstrual or acrid discharges. However, the affection is 
usually due to contagion, for married men, whose wives suffer from 
leucorrhoeal discharges are rarely afflicted with urethritis. 

Among the causes of urethritis are mentioned masturbation, the 
use of bougies, stricture, prolonged excitement of the gentials, fer- 
mented liquors, internal use of cantharis or turpentine, cancer of the 
womb, vegetations in the urethra, ascarides in the rectum, acrid urine, 
etc., etc. 

Urethral gonorrhoea in males is a violent inflammation of the 
mucous membrane of the urethra, accompanied by a muco-purulent 
discharge, is usually produced by the contact of a specific virus, 
and is by far the most frequent affection arising from sexual indul- 
gence. The word gonorrhoea, we should have stated, literally means 
a flow of sperm ; the disease was so named because the older writers 
considered the discharge a flux of semen. Of the nature of the 
specific virus which gives rise to this affection, but little is known. 
The discharge containing it does not differ, chemically or microscop- 
ically, from mucous discharges occurring in other situations. It has 
been definitely ascertained, however, that the virus is not identical, 
but is distinct from that of syphilis, and that it does not affect any 
other tissue except the mucous. The specific poison is found usually 
in a purulent discharge from the urethra, although the mucous mem- 
brane of the anus, mouth, eye or nose may furnish the same specific 
discharge if inoculated with the poison. 



GONORRHCEA 71 



Men are more liable to contract gonorrhoea than women, and the 
parts usually affected are the urethra, inner surface of the prepuce, 
and the head of the penis ; in the female, the urethra is not often 
affected, the disease being confined to the vagina, mucous membrane 
of the vulva and uterus. 

The disease manifests itself, without any period of incubation, 
from two to eight days after an impure connection; that is, the symp- 
toms are not well marked before the second to eighth day, although 
the poison probably acts immediately upon the affected tissue. In 
rare cases, the disease is developed in a few hours ; in others, again, 
the affection does not make its appearance for fourteen days. Males 
with a large orifice of the urethra, and those with a long narrow 
prepuce, are most subject to the disease. 

The symptoms make their appearance in the following order : 
the first being a slight titillation along the course of the urethra and 
at the end of the penis, increased considerably by an erection. This 
symptom is usually, not always, accompanied by a feeling of weight 
in the penis. The seat of the disease is at first limited to the ante- 
rior portion of the urethra, but soon extends to the bulbous and 
membranous parts. Upon examining the penis, the orifice is found 
to be red, swollen, and stuck together by a thin, whitish secretion; 
if the penis is pressed between the thumb and finger, a small 
quantity of watery mucus oozes out ; there is not much scalding or 
burning in urinating at this time — a slight smarting being felt 
only in the anterior portion of the canal during micturition. The 
foregoing are the usual symptoms of the first stage, which con- 
tinues from two to four days. 

In a short time, say a week or less, the discharge becomes abun- 
dant, thick like cream, and of a bright yellow or green color, stain- 
ing the linen ; or in some cases the discharge is mixed with blood, 
or consists of pure blood, due to the rupture of some minute blood- 
vessel. A slight hemorrhage is sometimes a benefit rather than a 
detriment, as it relieves the congestion of the swollen parts. The 
glans penis now becomes hot, red, swollen, tender and painful, and 
the prepuce enlarged and cedematous. 

General febrile disturbance is often well marked in first attacks* 
but not in subsequent attacks. The pain in voiding urine is now 
very severe, and extends the whole length of the canal, the patient 
feeling during the passage of urine as if he could bite a nail in two. 



72 PATHOLOGY OF GONORRHCEA 

The stream is apt to be forked or twisted. Erections occur almost 
nightly, often several times a night, producing excessive pain and 
hindering sleep. Chordee is the term applied to this form of erection, 
the penis being bent in the form of an arc with its concavity down- 
ward. 

In many cases, in addition to these symptoms, there are tensive 
and drawing pains in the spermatic cords, testicles, perineum, and 
groins. The disease is now at its height, and from this time on the 
symptoms become less severe ; the inflammatory or second stage is 
over, the erections occur but seldom, and the burning during micturi- 
tion is slight. The duration of this stage varies from seven to twenty 
days, according to the habits and surroundings of the patient. 

The disease rapidly subsides, leaving a whitish, viscid, stringy dis- 
charge, which gradually disappears, or remains for a long time, when 
it is called gleet. The duration of this, the last stage, is apt to be 
greatly prolonged when not influenced by the proper medicine. Re- 
lapses or aggravations from the neglect of hygienic and other laws of 
health are quite frequent. Everything which tends to irritate the 
urethra or genital organs should be strictly prohibited. 

A discharge similar to gonorrhoea in its nature is sometimes 
occasioned by leucorrhoea, or by the menstrual flow, by excessive 
sexual intercourse, by the exposure of the parts to a cold wind, by 
want of cleanliness, and by the use of new wine, stimulants or un- 
fermented beer. It is not easy to distinguish this form of gonorrhoea 
from the Simon-pure article when there are no other complications 
present, except that the symptoms are, as a rule, very much milder. 
The persons most liable to suffer from this form are those of a rheu- 
matic or scrofulous diathesis, or those who have become weakened 
through any cause. We meet with many cases which have received 
no treatment whatever, and the duration seems to be indefinite. 

In regard to the pathology of gonorrhoea, it is only necessary to 
state that it is an inflammation of the mucous tissue of the urethra, 
commencing at a small spot in the anterior portion of the canal, ex- 
tending backward its entire length, and forward involving the pre- 
puce. The inflammation rarely involves the peri-urethral cellular 
tissue. This membrane presents the same appearance as inflamma- 
tion of other mucous structures. It becomes red, the follicles are 
enlarged, there is hyper-secretion of mucus, becoming purulent 
and the membrane becomes thickened, diminishing the size of 



GONORRHCEA. 7$ 



the canal and of the stream. As the inflammation subsides, the sur- 
face becomes marked with patchy redness and fine granulations re- 
sembling small warts. When the inflammatory action is unusually 
severe, there is an effusion of lymph or plastic matter into the spongy 
substance of the urethra, causing that painful affection known as 
chordee. 

Should the peri- urethral tissue be invaded at any time, abscesses 
are liable to form, which may or may not communicate with the inte- 
rior of the canal, but are apt to cause ulceration of the mucous mem- 
brane from without inward and open internally. " The result is a 
communication which permits infiltrations of urine, and which may 
become the commencement of a urethral perforation." 

Gonorrhoea may be complicated with balanitis, phimosis, paraphi- 
mosis, general inflammation of the penis, orchitis, prostatitis, nephri- 
tis, crystitis, chancre, bubo, retention of urine, haemorrhage, phlebi- 
tis of the penis, conjunctivitis, arthritis, or abscess of the urethra, 
prostate gland or perineum. Balanitis, or gonorrhoea spuria, is sim- 
ply an inflammation of the head of the penis and prepuce, and it is 
usually a very insignificant affection, but occasionally gangrene 
results, giving rise to very odd deformities. We need not dwell upon 
phimosis and paraphimosis, having already considered these affections 
in a former lecture. 

General inflammation of the penis is rare, and yields readily to 
treatment. It is characterized by an erysipelatous redness and tume- 
faction of the whole organ. Rhus acts well in this complication : 
so also does Aconite. 

Cystitis, or inflammation of the bladder, is due to the extension 
of the inflammation from the urethra to the bladder, and rarely occurs 
until the fourth week. As predisposing causes, may be mentioned 
the use of irritating injections, abuse of alcoholic stimulants and 
overwork. The diagnostic symptoms are the passage of a few drops 
of blood at the close of micturition, with vesical tenesmus, itching 
in the head of the penis and constipation. 

It must be understood that the inflammation seldom if ever im- 
plicates more than the neck of the bladder. 

Chancre, of course, is not caused by the gonorrhceal poison, but 
may exist at the same time. Bubo may also be present in connec- 
tion with the chancre, or may follow the gonorrhoea. In the latter 
case, the bubo will be found usually on but one side, and below Pou- 



74 ORCHITIS— PR OSTA TA TIS. 

part's ligament — the number of ganglions involved varying from one 
to four. Retention of urine is occasioned by spasm of the neck of 
the bladder, excited by inflammatory irritation of this structure. 
Haemorrhage, I have already stated, is due to the rupture of some 
minute blood vessel of the urethra. It is of rare occurrence, and 
takes place only during a violent erection or prolonged sexual excite- 
ment. 

Orchitis, or gonorrhoeal epididymitis, as it is now termed, is 
usually the result of a repulsion of the gonorrhoeal inflammation by 
exposure to cold, or by the use of powerful injections, as the nitrate 
of silver, sulphate of copper, etc. Yery rarely indeed is it occa- 
sioned by the continuous extension of the inflammation to the epi- 
didymus. The left testicle is more frequently attacked than the 
right, although, in some instances, the inflammation see-saws from 
one to the other. The epididymus proper is the part chiefly 
involved in the majority of cases. Next to this, the tunica vaginalis, 
and lastly the spermatic cord. But it is not unusual for the three 
parts to be affected at the same time. It is rare, however, for any 
one of the three to be implicated alone. We need not take the time 
to here give the symptoms of this inflammation, as they have already 
been considered by your professor of surgery ; suffice it to say that 
the organ is at first swollen, tender to the touch, and on motion, the 
pain increasing, in many cases, to that degree that sleep is impos- 
sible, and the weight of the bed-clothes unendurable. Febrile dis- 
turbance accompanies in the majority of cases, but in others the 
patient is able to attend to his business. The termination is usually 
favorable, but exceptionally abscesses form in the cellular tissue 
underlying the scrotum, or even in the testicle. 

Phlebitis of the penis is a very rare and unusual complication. 
Abscesses of the urethra, perineum and prostate gland are also very 
rare ; they are due generally to, or at least happen in, persons affect- 
ed with, stricture of the urethra. 

Prostatitis, occurring in connection with gonorrhoea, occurs after 
the second week, and is due to the extension of the inflammation to 
the substance of the prostate gland. Irritating injections, exposure 
to cold and wet, protracted exercise and the use of alcoholic stimu- 
lants are predisposing causes. The patient complains first of a sense 
of weight in the perineum, followed by frequent and urgent desire 
to urinate, the stream being small and requiring considerable strain- 



GONORRHCEA. 75 



ing to force it out. Scalding, if present, is felt in the deeper por- 
tion of the canal. Constipation, with frequent and ineffectual urg- 
ing to evacuate the bowels, is often a well-marked symptom. On intro- 
ducing the finger into the rectum, the prostate gland will be found 
to be enlarged and very sensitive to pressure. Prostatitis usually 
terminates in resolution, rarely in suppuration. Should suppuration 
occur, it is recognized by chilly sensations or a pronounced chill, fol- 
lowed by high fever. Complete retention of urine is not uncommon 
in bad cases. The abscess may break and empty into the urethra, 
the bladder or the rectum, according to its situation. The rectum 
usually receives the contents of the abscess, and the termination is 
eventually satisfactory. 

Cowperitis, or inflammation of Cowper's glands, is an occasional 
complication. The symptoms are similar to those of prostatitis, with 
which it is frequently associated. There is pain, deep seated, in the 
perineum, and suppuration is by no means an unusual termination. 
A urinary fistula may be the result. 

Arthritis, or gonorrhoeal rheumatism, is by no means a frequent 
affection, occurring in less than one per cent of all cases, and only in 
connection with urethral inflammation. The exciting causes are not 
known. 

The knee joint is the part most frequently affected, although no 
joint seems to be exempt. Compared with ordinary rheumatism, we 
find that the pain is never as great, the fever much less, the sweat- 
ing absent, and the disease is not inclined to shift from one joint to 
another. The duration seldom exceeds five or six weeks at the 
most, under proper Homoeopathic treatment. In badly treated cases, 
the duration may be indefinite and anchylosis the result. 

Gonorrhceal ophthalmia is a frequent complication and a serious 
one. The virus is carried from the penis to the eye by the finger of 
the affected individual. The conjunctiva is the part usually affected, 
although the iris and cornea may be involved, as the vessels of the 
tissues of the eye are intimately connected. When the conjunctiva 
alone is affected, the discharge is muco-purulent. 

Chordee, as we have already stated, is present to a greater or less 
degree in nearly every case of gonorrhoea, coming on specially at 
night, after getting warm in bed, and it does not as a rule disap- 
pear at the close of the inflammatory stage. It is always attended 
with some pain, but when the penis, during the erection, is bent 



76 GONORRHfEA OF WOMEN. 

back toward the perinaeum, the suffering is intolerable. Hemorrhage 
from the urethra sometimes accompanies the erection. 

Stricture of the urethra often follows gonorrhoea, in consequence 
of the use of very irritating injections. Such a result does not often 
follow proper Homoeopathic treatment. I say this because I have 
never yet seen a case of stricture following gonorrhoea that was not 
directly or indirectly due to nitrate of silver or other powerful injec- 
tions. The treatment of stricture, aside from remedial agents, 
will be considered by your professor of surgery. 

Gonorrhoea in the female is much less common and far less 
troublesome than in males. The reason for this partial immunity of 
women is owing to the fact that their parts are more or less protected 
by the natural secretion of the numerous glands ; and secondly, by 
the fact that men are, in most cases, compelled to abstain from sexual 
intercourse while suffering from the disease. Owing to the fact that 
their menstrual and other discharges are frequently poisonous to the 
male urethra, women may be said to more frequently communicate 
than receive gonorrhoea. If the attack comes on suddenly in the 
female, accompanied by heat, pain and burning along the course of 
the urethra, aggravated during urination, and accompanied by a 
discharge from the meatus, we may be pretty certain what the mat- 
ter is, for no form of leucorrhoea is attended with a discharge from 
the urethra. But gonorrhoea of the female urethra is the rarest of 
affections, for the reason that during coition the urethra is not apt 
to come in contact with the penis — the vulva, vagina and uterus 
being the parts most exposed. It is in chronic cases and in cases of 
infection of the vulva, vagina and uterus, where the previous history 
cannot be ascertained, that it is impossible to make out the diagno- 
sis positively ; but that need not interfere with your promptly curing 
the case. Dr. Ash well says : " It is the duty of the physician to 
cure the disease, but rarely to venture upon an exposition of its 
nature. If he can positively affirm that it is of simple origin, let 
him do so, if suspicion has been aroused ; if not, it is better to avoid 
any distinct allusion to the matter." 

My friend, Dr. Jessen gives the following differential diagnosis : 
— i The history of the attack furnishes more important aid to its diag- 
nosis. Gonorrhoea has a very short period of incubation, and, as a 
rule, its symptoms advance with a rapidity and acuteness which is 



DIFFERENTIAL DIAGNOSIS. 77 

rarely met with in catarrhal inflammations. Therefore, if the sexual 
organs suddenly become the seat of a burning pain, which is soon 
followed by an itching irritation, with painful desire to urinate, 
increased sexual appetite, swelling, and local pain, with blenorrhagia, 
where no local irritants have been applied, and there is no trauma- 
tism, there is good reason to believe that the case is gonorrhoeal, and 
not leucorrhoeal ; for leucorrhoea, with which this affection is most 
likely to be confounded, develops slowly, or, so to speak, has a chron- 
ic stamp from its very beginning. 

11 Where the symptoms of a catarrhal leucorrhoea and of a gonor- 
rhoeal inflammation are pronounced, the experienced physician will 
be clear in his diagnosis, but when the inflammation is slight, and 
the discharge is mild in its character, he will have more trouble in 
differentiating them. This is especially true if the woman is inter- 
ested in concealing the real nature of her disease. 

" In utero-vaginal catarrh, the general symptoms are congestion, 
inflammation and exudation, just as in catarrhal inflammations that 
are located elsewhere. These symptoms are identical with those of 
gonorrhoea, but in the latter affection they are characterized by a 
more rapid course and a greater degree of intensity, by an especial 
proneness to involve the urethra, and also the inguinal glands. 

"The principal features of catarrhal inflammation are hyperae- 
mia, swelling and structural changes, as oedema, with increased for- 
mation of epithelial cells, mucus and pus. In severe gonorrhoea of 
the vagina, for example, there is a copious secretion of serum from 
the vaginal follicles, but there is no great soreness of the vagina 
itself. In the mucous stage, there is considerable tenderness, which 
increases as the case passes into the purulent form. In both, the 
secretion, which, from having been whitish or yellowish and slimy, 
becomes creamy, greenish and purulent, with an acid re-action. This 
last symptom is important, because the secretions from inflamed mu- 
cous membrane in other parts of the body are always alkaline. In this 
stage the discharge has a peculiar, strong and offensive odor." 

Urethral gonorrhoea, although rare by itself, is sometimes asso- 
ciated with vulvitis or vaginitis, in which case the itching and smart- 
ing of the urethra is seldom very troublesome. It never gives rise 
to cystitis, although the inflammation may extend as far as the 
neck of the bladder and then cause considerable pain on micturition. 



78 VULVITIS. VAGINITIS. 

We have already hinted that in women several portions of the 
genital organs are affected, so that we may find in addition to or 
independent of urethritis, vulvitis, vaginitis or metritis. Inflamma- 
tion of the parts composing the vulva is less common than vaginitis, 
and when not occasioned by the gonorrhoea! virus, may be due to 
uncleanliness, masturbation, frequent coitus, chancre, injuries of the 
parts and numerous other causes. Vulvitis is analgous to balanitis 
in the male. It is said that when the inflammation is limited to the 
clitoris it is a sign of masturbation, and that when it commences at 
the fourchette and base of the labia minora it indicates an attempt at 
rape or repeated coitus. We need not repeat that the diagnosis is 
difficult and must frequently be made by the process of exclusion. 

The symptoms do not differ materially from those of inflamma- 
tion of other mucous membranes, consisting at first of heat and itch- 
ing, with a reddened, tumefied and moist surface. In a very few 
days the discharge increases, becoming muco-purulent and quite 
offensive. There is much sensitiveness to touch, and the inflamed 
parts are painful on motion. Whenever the urine comes in contact 
with the inflamed parts, there is severe burning pain, and even the 
discharge irritates and inflames the skin if allowed to remain in con- 
tact with it. Nymphomania, or at least increased sexual desire and 
very painful coitus, are attendant symptoms in the majority of cases. 
If the disease is not speedily relieved by treatment, ulceration of the 
parts is apt to occur, and in some instances, an abscess in the groin. 

Vaginitis, acute or chronic, may be due to contagion, but there 
are numerous causes which may produce it, viz., sexual excesses, 
ascarides, or foreign bodies in the vagina, the use of pessaries, unclean- 
liness, masturbation, syphilitic - or other eruptions, exposure to cold 
and moisture and the eruptive fevers. G-onorrhoea of the vagina is 
more common than that of the urethra, vulva or uterus, and it is 
less painful than when the vulva is affected. The main symptoms 
are, at first, dryness, redness and tumefaction, with increased heat 
and sensibility ; some pain on motion ; frequent desire to urinate, 
with some smarting ; dull pain in the hypogastric region ; acid dis- 
charge, at first thin and transparent, later, offensive, purulent, of a 
yellowish or greenish color, and sometimes bloody. It is very prone 
to become chronic, although the acute symptoms yield to treatment 
in a very short time. Contraction of the vagina may follow, and 
may even be so great as to completely occlude the canal. 



GONORRHCEA OF UTERUS. 



Gonorrhoea of the uterus is not uncommon, but is less frequent 
than that of the vagina or urethra. It is very rarely primary, but is 
usually owing to the extension of the vaginal inflammation. There 
is no pain of consequence, but usually some slight disturbance of 
digestion, general malaise and irregular menses. The discharge is 
alkaline, whitish and gelatinous, and irritates the vagina while pass- 
ing through it. 

The complications in women are not so numerous nor so severe 
as in men. Bubo, inflammation of the Fallopian tubes, ovaritis, 
chancres and vegetations are the main complications, but, with the 
exception of chancre, are quite rare. Bubo, except when due to 
chancre, is less frequent in women than in men suffering from gon- 
orrhoea 

Prophylactic Treatment. — Whether the prophylactic treatment 
01 this affection should be made to the general public or not, is a 
question. As the disease is usually the result of an impure connec- 
tion, the parties should suffer for their misdemeanors. Still we give 
you the best means known of preventing the disease. The parts 
should be well anointed with oil before, and well washed after con- 
nection. If these precautions are followed there is slight danger of 
infection. 

In regard to the treatment after the disease is fully developed (and 
we may here say that it is often obstinate and rebellious to our best 
endeavors), the following general directions should be given to the 
patient : Take no more exercise than is absolutely necessary ; keep 
in bed if possible ; keep the parts clean by bathing them in warm 
water, and by placing pledgets of lint between the prepuce and head 
of the penis ; if obliged to be on the feet much, suspend the parts 
in a suspensory bandage ; avoid stimulants, coffee, acids and 
meats, living on rice, bread, barley water, gum water, weak tea, 
etc. Avoid all impure thoughts. As for the remedies to be em- 
ployed, every author and physician has his own peculiar set. The 
symptoms should decide in this affection as in other diseases, if you 
can get hold of them, but many physicians always give the same 
remedy in the first stage of every case ; for instance, Grauvogl rec- 
ommends Natr. sulph.; Wahle, Bryonia; Jahr, Sepia; Baehr, 
Merc, sol; Kafka, Sulph.; Berjeau, Aeon.; and many others Can- 
nabis. It is seldom, however, that we see cases in the first stage, 
as many persons imagine that while they have gonorrhoea they can 



80 TREATMENT OF GONORRHCEA. 

contract no other disease, and thus let it run, and they are also ac- 
quainted with the fact that often the disease subsides without treat- 
ment. 

If we see a patient in the onset of the disease, we administer 
Aconite, which is often sufficient to cure the affection. The patient 
complains of burning in urethra when urinating, dysuria, and some- 
times of tenderness of the neck of the bladder. If this drug 
does not control the inflammation, we are obliged to resort to Gels., or 
some other remedy. Almost every drug in the Materia Medica has 
been recommended for gonorrhoea, but, in speaking of the different 
remedies, we shall confine ourselves to those which have been found 
curative for a certain definite set of symptoms. We shall speak of 
them, not according to their real and comparative value, but alpha- 
betically. 

Agave Americana has been recommended for " excruciating, 
painful erections, chordee, strangury, drawing in the spermatic cords 
and testicles, extending to the thighs, so violent that he wishes to 
die.' 

Agnus castus is indicated in " old sinners " (when the inflamma- 
tory symptoms have subsided), who have no sexual desire or erec- 
tions, especially if the discharge is yellow and purulent. 

Ant. crud. Hempel mentions this remedy and says it should be 
used in tolerably large doses. The symptoms indicating it are: 
Burning when urinating, the urine being mixed with blood ; " the 
urethra feels sore to the touch, knotty ; the emission of urine may 
even be completely repressed." 

Argentum nit., the great remedy, used as an injection in old school 
practice, may be successfully employed, homoeopathically, for the fol- 
lowing symptoms : Burning during urination, with a sensation as 
if the urethra were closed and sore inside, or swollen inside ; the last 
few drops of the urine are not emitted ; in addition, there is a cutting 
pain extending to the anus, and a discharge of pus excoriating the 
parts (male or female). It may also used for swelling of the penis, 
chordee, or for enlargement and induration of the testicle in conse- 
quence of suppressed gonorrhoea. 

Berjeau recommends Arsenicum in gonorrhoea of the female, 
"when there is smarting, gnawing discharge, causing soreness of 
the parts with which it comos in contact ; when standing, the dis- 
4}harge drops down, accompanied with emission of flatulence ; or when 



TREATMENT OF GONORRHCEA 81 

there is also great redness of the parts." In the male, it has been 
successfully employed for tearing deep in the urethra. 

Aurum is also recommended by the same author " for profuse 
discharge which excoriates the perineum and inner parts of the 
thigh, with vesicular eruptions on these parts, or when labor-like 
pains are present." This remedy will be found useful also where 
there is inability to retain the urine, or for stricture of the urethra, 
with continual urging to urinate. 

Byronia is another useful remedy in gonorrhoea of the male or 
female, when the discharge, which had almost ceased, increases again. 
Valuable when the labia are greatly swollen. 

In regard to the curative power of Cannabis in this affection, 
there has been considerable dispute. Some assert that it is almost a 
specific. The remedy is certainly of service when the symptoms 
indicate it ; when they do not, it is about as valuable as most of the 
new remedies which have been declared specifics in gonorrhoea. It 
is indicated in the inflammatory stage, when the urethra feels as if 
drawn up into knots ; when the prepuce is greatly swollen and sensi- 
tive to the touch ; when there is constant urging, with difficult urin- 
ation ; when there is dark redness of the glans and prepuce ; and 
when chordee is a prominent symptom. Hempel recommends it for 
the symptoms which frequently accompany gonorrhoea, as rush of 
blood to the head, frontal headache, etc., but his doses are hardly 
what could be called homoeopathic. He advises the practitioner to 
give as high as fifteen to twenty drops of the strong tincture for a 
dose. If Cannabis is the indicated remedy, the 30th or 200th will 
act better than the strong tincture. This remedy is also of service 
in gonorrhoea of the female, " when there is cutting between the 
labia during micturition, the orifice of the urethra also being closed 
with pus, there being violent sexual desire, with swelling of the 
vagina." 

Caniharis is sometimes called for when the inflammation extends 
to the bladder, with tenesmus ; constant desire to urinate, passing 
but a few drops at a time, often mixed with blood ; great difficulty 
in urinating, with intense pain ; the discharge is yellow or bloody ; 
excessive sexual desire, with erections at night. In the female, it is 
indicated for swelliDg of the neck of the womb, for pains in the kid- 
neys and copious debilitating discharges, especially if the symptoms 
are accompanied with constant desire to urinate. 



82 TREATMENT OF GONORRHOEA. 

Some authors advise Capsicum for intense burning in the ureth- 
ra, with white, cream-like discharge ; and others for thick, purulent, 
yellow discharge, accompanied with pricking, burning, cutting pains 
in the urethra. 

Gocculus is occasionally of benefit, especially " when there is 
tensive, aching pain in the orifice of the urethra when not urin- 
ating." 

Copaiba, Berjeau says, is indicated " for a violet smell of the 
urine, or when the discharge is accompanied by a cutaneous erup- 
tion like measles or nettle rash, attended with great itching." It is 
also useful for yellow, purulent discharges from the urethra, and for 
bloody urine, with constant desire to urinate. 

Berjeau also recommends Cubebx for the same violet odor of the 
urine, especially when the discharge is dark and reddish. It is use- 
ful for retention of urine also. 

Calc. carb. is a useful remedy in gonorrhoea of the female, when 
the discharge is burning or milky ; also in gleet, especially in fat, 
lymphatic persons. The general symptoms are well marked when 
this remedy is called for. Cham., likewise, may be used in gonor- 
rhoea of the female when the discharge from the vagina is yellow, 
acrid, smarting or watery. 

Carbo. veg., if the gonorrhoeal discharge is very offensive, will 
prove curative. 

Conium we have used when the testicles were indurated, espe- 
cially if the patient had been the subject of frequent nocturnal 
emission?. 

Hempel advises Dulc. for gonorrhoea from suppressed tetter. 

Hydrastis has been used as an injection with more or less relief 
of the smarting during urination. 

Hepar sulphuris has been found of service in scrofulous persons 
when the discharge is white, yellow or fetid. 

Kali nit. is used by the French and others physicians for fre- 
quent urging to urinate, with burning during and after urination. 

In gonorrhoea of the female, Kreas. is of service if the discharge 
is bloody, acrid or yellowish, and of a foul odor, especially when 
accompanied with smarting in the external parts. 

Merc, should always be used when the gonorrhoea is complicated 
with chancre or phymosis, unless the remedy has already been used 
to excess, when Nit. ac. would be better adapted to the case. It is 



TREATMENT OF GONORRHCEA. 83 

also indicated when the discharge is yellowish, green or purulent, 
aggravated at night. When the gonorrhoea is not complicated with 
chancre, we prefer Merc, cor., but when there is a chancre we use 
Merc. sol. to the best advantage. Berjeau also recommends this 
remedy " when the orifice of the urethra is inflamed, and the fore- 
part swollen with suppuration between the glans and prepuce, the 
glans being red, hot and painful when touched, accompanied with 
burning pain and itching, stinging and throbbing in the urethra, the 
urine passing with a feeble stream." In the female it will prove 
serviceable if the vagina is swollen and inflamed, with a sensation of 
rawness or excoriation, the discharge being acrid or greenish and 
purulent. 

Dr. Raue recommends Mezereum for hasmaturia during gonor- 
rhoea. The discharge is thin and watery, greatly increased by exer- 
cise, and the urethra is very painful to the touch. 

Millefolium has been used when the discharge consists of blood 
and watery slime, with swelling of the penis. 

Nat. mur. is the best remedy to administer after the patient has 
used injections of nitrate of silver. 

Nit. ac. will be found of benefit in cases which have been badly 
treated with Merc, especially when accompanied with chancres or 
balanitis. Some authors have recommended this remedy also for con- 
dylomata. Nit. ac. is just as useful in gonorrhoea of the female as 
of the male. 

Nux vom. is an excellent remedy when the patient has been 
treated allopathically with copaiba, cubebs, and other hot stuffs. 
The symptoms indicating it are constipation, haemorrhoids, " pres- 
sive pains occurring at the orifice of the urethra when not urinating, 
accompanied with shuddering," and sharp, cutting pains near the 
orifice of the urethra, with more or less dull pain in the back of the 
head. In the female, it is indicated for swelling of the vagina, which 
is ve>y sensitive to the touch ; for "gnawing, itching eruptions on the 
genitals; for painless discharge of yellow mucus or fetid mucus, with 
burning in the parts, and violent sexual desire." 

Petroselinum may be used for tickling and itching in the urethra, 
especially near the root of the penis, with constant desire to urinate. 
The discharge is milky or yellowish. 

Phosphorus is of service in the female when there is decided 
aversion to an embrace, especially if the discharge is milky. 



84 TREATMENT OF GONORRHCEA. 

Pulsatilla should be thought of in mild, timid persons, when 
the discharge is very abundant, no matter what the color ; also in 
suppressed gonorrhoea, with swelling of the testicles. It is also use- 
ful in gonorrhoea of the female, when there is considerable pain in 
the uterus, vagina and labia. 

Sulphur is important as an intercurrent remedy in persons of 
a scrofulous diathesis. In some cases it is sufficient to complete the 
cure, especially when there is considerable burning at the orifice of 
the urethra, accompanied by constant desire to urinate, the stream 
being smaller than usual. In the female the same general consider- 
tions indicate it, and in addition, " itching of the clitoris and 
and burning of the exterior parts, accompanied with vesication, 
attended with a smarting, burning, thin discharge, especially in the 
morning." 

Thuja would be indicated if fig-warts were present, but, as we 
have already stated, they are generally an accompaniment of secondary 
or tertiary syphilis, and not of gonorrhoea. We might mention fifty 
other remedies which have been recommended in this disease, but 
enough has been said already in regard to the treatment, which is, at 
best, often unsatisfactory. 

It has been stated time and again that the high potencies are 
powerless in the treatment of gonorrhoea and syphilis. This is a 
great mistake, and the cases now under treatment at the hospital, 
prove the truth of the assertion, that the properly selected remedy 
will cure in the 30th and 200th attenuation. 



REPERTORY. 



GONORRHCEA OR GLEET OF MEN. 

Urethra, aching in — Bry., Canth. 

aching after micturition — Puis. 

aching at the orifice — Canth., Nux-vom. 

aching, with pressure — Cannab. 

agreeable sensation in, during micturition — Gels. 

agglutination of orifice — Calc, Cannab., Natr-m., Petros. 

biting pains in the fore part — Cannab., Copaib., Merc. 



REPERTORY. 85 



Urethra, biting pains during micturition — Ars., Canth., Cham. 
Graph., Merc, sol., Natr.-m. 

biting pains after micturition — Copaib. 

biting pains when not urinating — Berb., Cannab. 

burning pains — Bry., Canth., Con., Thuj. 

burning pains morning after erection — Natr-m. 

burning pains morning during micturition — Flu-ac, 
Seneg. 

burning pains morning after micturition — Con., Flu-ac, 
Thuj. 

burning pains forenoon after micturition — Lye 

burning pains forenoon during micturition — Lye. 

burning pains afternoon during micturition — Hell., Natr- 
c, Thuj. 

burning pains evening — Natr-c, Petr., Phos., Sulph. 

burning pains evening during micturition — Seneg. 

burning pains evening after micturition — Sep. 

burning pains night — Canth., Sulph. 

burning pains night after micturition — Thuj. 

burning, before micturition — Bry., Cannab., Merc. 

burning at commencement of urination — Cannab., Merc. 

burning during micturition — Ac, Agar., Agnus., Ant-c, 
Ant-t., Arg-nit., Ars., Aur., Bov., Calc, Cannab., 
Canth., Caps., Carbo-veg., Caust., Chin., Clem., Cocc, 
Colch., Con., Copaib., Cubeb., Hep., Lye, Merc, 
Mezer., Millef., Natr-c, Natr-m., Natr-sul., Nit-ac, 
Nux-v., Petr., Petros., Sep., Sil., Staph., Sulph., 
Thuj. 

burning, extending into bladder, after urination — Lye 

burning, at the orifice — Canth., Caps., Nit-ac, Puis., 
Sep., Thuj. 

burning, with itching — Apis., Copaib. 

burning, with soreness of prepuce — Chin. 

burning, with stitches — Cannab. 

burning, with stitches in forepart — Bry. 

burning in middle of, when not urinating — Staph. 

contraction of — Bry., Canth., Clem., Puis., Sulph. 

crawling pains, extending backward — Camph., Nux. 

crawling, after micturition — Canth. 



86 GONORRHCEA AND GLEET. 

Urethra, crawling, when not urinating — Mezer. 
crawling, in morning in bed — Petros. 
crawling, when moving — Thuj. 
cutting, morning during micturition — Graph., Merc, 
cutting, evening before micturition — Bry., Calc, Canth., 

Phos.-ac. 
cutting, evening during micturition — Calc, Canth., Car- 

bo-v., Con., Hep., Puis., Rhus, 
cutting at close of micturition — Natr-m, Sulph., Arg-nit- 
cutting, after micturition — Calc, Canth., Natr-m., Sulph. 
cutting, extending backward- — Copaib. 
cutting, when not urinating — Caps, 
cutting, before and after stool — Sulph. 
drawing, morning after micturition — Carbo-v., Natr-m. 
drawing, when not urinating — Puis, 
drawing, extending to anus — Phos-ac 
hemorrhage from — Arg-nit., Canth., Lye, Merc, Nit-ac 
itching in forepart of — Aur., Canth., Cannab., Ign., 

Merc. 
pinching, before urination — Natr-m. 
pinching, when not urinating — Verat. 
pinching, during urination — Arg-nit., Carbo-v. 
sensation of dropping from, after micturition — Thuj. 
sensation as if burning drops ran along, after micturition 

— Arg-n. 
sensation of constant urging to urinate — Sulph. 
soreness at the meatus — Copaib., Clem., Nux., Nit-ac 
soreness, internal, continuing after urination — Arg-nit., 

Nux. 
stitches in — Aeon., Apis., Arm, Aurum, Calc, Cannab., 
Canth., Cocc, Con., Ign., Merc, Sep., Sulph., Thuj. 
stitches in, when not urinating — Bell., Caps., Cannab., 

Phos-ac. 
stitches in, while walking — Ign. 
stitches in meatus — Phos-ac. 
stitches in, extending to abdomen — Merc, 
stinging, when not urinating — Phos-ac, Thuj. 
tearing in the forepart — Ant-t., Lye, Thuj. 
tearing, when not urinating — Ars., Bry., Ruta., Sulph. 



REPERTORY. 87 



Urethra, tearing, extending to the perinseum — Mezer. 
throbbing in — Copaib., Hep., Merc. 
twitching pain in — Petr., Thuj. 
Ineffectual desire to urinate — Canth., Sarsap. 
Spermatic Cord, pain in — Puis., Spong. 
Testicles, pain — Arn., Aur., Clem., Con., Nux, Puis., Spong. 
Cowper's Gland, itching and pressure — Petros. 
Genitals, coldness of — Gels. , Lye. 

sweat of — Gels. 
Discharge, acrid — Copaib., Creas. Sarsap. 

albuminous — Petros. 

bloody — Canth., MillefoL, Nitr-ae. Puis 

green — Merc. 

milky — Copaib., Lach., Petros. 

mucous — Caps., Ferr. 

offensive — Carbo., Pals., Silic. 

of pus — Agnus., Bar., Caps., Copaib., Con., Natr-m. 

thin — Natr-m., Phos-ac, Phos. 

transparent — Mezer., Phos ae 

watery and slimy — Cannab., Natr-m., Thuj., Fluor-ac. 

yellowish — Agnus, Canth., Calc, Caps., Hep., Nit-ac, 
Sarsap., Thuj. 

increases, after having decreased — Bry. 



GrONORRHCEA OF WOMEN. 

Urethritis — Aeon., Canth., Cannab., Gels., Thuj 

Vulvitis — Bell., Bry., Calc, Canth., Cannab., Carbo., Con., Creos., 

Lye, Merc, Nit-ac, Sabin., Sep., Sulph., Thuj. 
Vaginitis — Aeon., Bell., Cham., Calc, Canth., Creos., Nux., Nit- 
ac, Puis., Sabin., Sep., Sulph. 
Metritis — Aeon., Ars., Bell., Bry., Canth., Carbo-v., Coloc, Con., 
Creos., Ign., Hep., Nit-ac. Phos., Plat., Puis., Sep., 
Sulph., Lach., Lye, Merc, Nux. 
Discharge, acrid — Alum., Ars., Aurum , Cham., Creos., Ferr., 
Ign., Merc, Phos., Sabin , Sep., Sil., Sulph. 
bloody — Chin., Cocc, Lye, Nitr-ac, Sabina. 
greenish — Cubeb, Merc, Natr-m., Puis., Sep. 



88 GONORRHOEA OF WOMEN. 

Discharge, milky — Calc, Creos., Gels., Lye, Phos., Puis., Sep., 
Sil., Sulph. 
mucous — Bell., Calc, Mez., Nitr-ae, Nux., Phos. 
offensive — Creos., Nux., Nitr-ac., Sabin., Sep. 
watery — Cham , Creos., Ferr., Graph., Merc., Sulph., 

Sep. 
yellow — Ars., Cham., Creos., Merc, Nux. Stann., 

Sep., Sulph. 
purulent — Ign., Merc, Sabin , Sep. 
Before Urination, burning — Apis., Bry., Calc, Camph., Canth., 
Caps., Puis, 
cutting — Bry., Camph., Canth. 
cutting in abdomen — Nit-ac, Sulph. 
colic — Puis. 

contraction in urethra and rectum — Natr-m. 
discharge of mucus — Creos. 
impatience — Sulph . 

pressing pain — Merc, Nux., Puis., Petr. 
pressure in bladder — Am 
pain in neck of bladder — Nux. 
stinging — Nux. 
During Urination, anxiety — Cham. 

abdominal pains — Bry., Lye 
burning — Apis., Arg-nit., Am., Ars., Bell., 
Bry., Calc, Camph., Cannab., Canth., 
Caps., Caust., Cham., Chin., Con., Creos., 
Gel., Ign., Lye, Merc, Mezer., Natr-c, 
Natr-m., Nit-ac, Nux., Petr., Phos., 
Puis., Sil., Stann., Staph., Sulph., Thuj. 
burning in vulva — Creos. 
biting in orifice — China, 
biting — Ign., Mezer , Merc, Natr-m., Sep., 

Thuj, 
constriction in left groin — Ars. 
cutting — Calc, Canth., Con., Merc, Nit-ac, 

Puis., Staph., Thuj. 
drawing — Con. 
gnawing — Caust. 
itching — Arg-nit., Cham., Petr., Sulph., Thuj. 



REPERTORY. 



nausea — Merc, 
pinching about navel — Aeon, 
prickling — Caps, 
pressure upon uterus — Con. 
soreness — Calc, Cannab., Ign., Lye, Mezer., 
Natr-c, Nit-ac, Phos., Sil. 
At end of Urination, cutting pain in orifice of urethra — Am., 
Canth. 

dropping of blood — Cannab., Canth., Puis. 

After Urination, burning — Apis., Camph., Cannab., Canth., Caps., 

Chin., Con., Lye, Merc, Nit-ac, Puis., 

Thuj. 

cutting — Arg-nit., Camph., Canth., Caps., 

Mezer., Staph., Sulph. 
colic — Staph, 
crawling — Canth., Lye. 
dribbling — Arg-nit., Natr-c, Petr., Sulph.; 

Thuj. 
discharge of mucus — Nit-ac 
feeling as if more were to come — Stann. 
involuntary discharge — Sil. 
passes drops of blood — Mezer., Sulph. 
renewed desire — Calc. Nit-ac. 
soreness — Nux. 
stinging — Merc, Sulph. 
stitches — Arn., Con, 
tenesmus — Con., Sulph. 
tickling — Canth. 
weakness — Ars., Phos. 
During Menses [Only those symptoms are given here which are 
covered by less than seven remedies]. 

attacks of faintness in morning — Nux. 

asthma — Chin. 

agglutination of eyelids in morning — Calc. 

bloatedness — Alum., Cocc, Natr-c. 

bearing down — Bell., Thuj. 

breathing difficult — Calc 

breasts, pain in — Con., Merc Thuj. 

burning in eyes — Nit-ac 



90 GONORRHOEA OF WOMEN. 

During Menses, cramp in calves — Phos. 

cold perspiration on forehead — Phos. 

coughing up blood — Sep. 

clonic spasms — Chin. 

contraction in rectum — Cocc. 

convulsions — Cocc, Puis. 

coryza — Alum. 

constipation — Apis. 

colic — Aur., Chin., Natr-c. 

chills — Bell., Creos., Natr-c, Nux., Phos., Puis. 

coldness of limbs — Cham. 

general coldness — Thuj. 

diarrhoea — Alum. Caust., Cham., Creos., Natr-c 

deglutition painful — Calc 

darkness before eyes — Chin., Sep. 

dullness of teeth — Merc. 

drowsiness — Sulph. 

dryness and burning of tongue — Merc. 

epistaxis — Sulph. 

eruption — Apis., Con., Sil. 

eructation — Nit-ac 

ears, rushing sound in — Creos. 

ears, singing and roaring in — Petr. 

face-ach e — Na tr-m . 

face yellow — Caust. 

face, swollen — Chin. 

face, pale — Puis. 

feet, swelling of — Calc, Lye 

feet, heaviness of — Sulph. 

feet, cold — Sil., Sulph. 

foul taste — Sep. 

foul odor from mouth — Sep. 

flatus — Creos. 

gums swollen — Merc, Nit-ac. 

heat in head — Apis., Bell., Calc, Ign. 

heat in hands and soles of feet — Petr. 

hardness of hearing — Calc, Creos. 

itching of vulva — Lye 

inclination to commit murder — Merc 



REPERTORY. 91 



During Menses, improvement of mental condition — Stann. 

ineffectual straining at stool — Calc, Puis., Sulph. 

Jachrymation in morning — Calc. 

obscured vision — Puis., Sep. 

pain in ovary — Cham., Phos. 

pain in right ovary — Apis. 

pain in rectum — Apis. 

pain in limbs — Bell., Bry., Calc. 

perspiration of chest — Bell. 

perspiration of chest and back — Creos 

prolapse of rectum — Aur. 

pressure in epigastrium — Caps. 

pressure in abdomen as from a stone — Cocc. 

palpitation — Nit-ac, Sulph., Thuj. 

restlessness of the legs — Thuj . 

salty taste in mouth — Merc. 

stitches in rectum — Ars. 

stitches in chest — Con., Puis. 

stitches in side — Creos., Natr-c. 

spasms of stomach — Puis. 

sleeplessness — Sep. 

soreness about vulva — Sil. 

soreness of throat — Sulph. 

toothache — Ars., Calc, Natr-m., Nit-ac, Phos. 

thirst — Bell. 

twitching of eyelids — Natr-m. 

vomiting — Ign., Phos., Puis. 

vertigo — Nux., Sulph. 

weeping mood — Puis., Thuj. 



COMPLICATIONS OF GONORRHOEA. 

Abscess. — Apis., stinging pains; Asaf., dark red, hot; Bry., fre 
quent thirst ; Cham., pain of chronic ; Hep., hastens 
suppuration ; Lye, worse at 4 P. M. ; Petr., unhealthy 
skin, small wounds suppurate; Sil., prevents unsightly 
scars; Stram., violent pain, driving one mad. 



92 COMPLICATIONS. 



Arthritis. — Apis., stinging pains; Am., bruised feeling; Ars., 
restlessness, with relief from motion ; Aeon., high 
fever, thirst, anxiety; Bry., worse from motion; Benz- 
ac., scanty, dark brown, fetid urine; Calc., after 
Ilhus ; Kali-jod., great general debility ; Led., pains run 
up, worse in warmth of bed; Lye., old people, worse 
from 4 to 8 P. M.; Mezer, urine hot, with red sedi- 
ment ; Nux, habitual drinkers ; Puis., constant chill- 
iness, diarrhoea, thirstlessness ; Rhus, worse during rest, 
better from continued motion ; Sars., shooting pains 
in head ; Sil., acute pains remitting from time to 
time; Sulph, tearing pains from knee to crest of ili- 
um, left side ; Thuj., covered parts hot and dry, un- 
covered moist 

Balanitis. — Aeon., itching in prepuce; Am., injury; Bry., in- 
creased discharge after improvement ; Calc, scrofulous 
persons ; Cann., gets angry at trifles ; Caps., constant 
pressure in glans; Chin, burning in glans and pre- 
puce; Ign., nervous; Merc, purulent greenish secre- 
tion, worse at night; Mezer., fine, pricking stitche3 in 
the glans ; Nit-ac, discharge of bloody slime ; Nux., 
secretion, copious, worse evenings ; Phos-ac, gnawing 
pains; Puis., mild, gentle persons; Rhus, after get- 
ting wet; Sabin., violent erections ; Sulph., icy cold- 
ness and swelling, with redness of glans; Thuj., vio- 
lent stitches and soreness in the glans. 

Bubo. — Ant-t., quarrelsome; Apis, great pain and sensibility ; Ars., 
intense burning; Bapt., painless ; after exposure to cold; 
Carbo-an., constipation, passing flatus only; Carbo-veg., 
great prostration; Graph., scrofulous women; Hep., sup- 
purating; Merc, very painful; Nit-ac, after abuse of mer- 
cury ; Sil., scrofulous persons; Thuj.. with fig warts; Zinc, 
left side. 

Cowperitis. — Aeon., from cold; Cinn., increased sexual desire- 
Hep., when suppuration threatens ; Merc, desire to 
urinate after micturition ; Sil., after suppuration ; 
Thuj., much straining during urination. 



REPERTORY. 93 



€ystitis. — (See urinary complaints for indications.) Aeon., Apis., 
Arn., Ars., Bell., Calc., Cann., Canth., Caps., Carbo- 
veg., Caust., Coff., Coloc., Cupr., Dig., Dulc, Graph., 
Hell., Hep., Hyos., Lach., Lye., Nit-ac., Nux., Phos-ac., 
Puis., Ruta., Sars., Sep., Sil., Sulph., Thuj. 

Chordee. — Camph., acrid urine; Canth., bloody urine ; Caps., urine 
increased; Iod., frequent and inveterate urethritis ; Lup- 
ulin ; Puis., mild persons, predisposed to catarrh or diar- 
rhoea. 

Eczema or Herpes. — Arn., from irritation or injury ; Caust., rheu- 
matic subjects; Dulc, bleeding; Hep., after mer- 
cury or ointments; Merc, voluptuous itching- 
Petr., constant oozing, itching ; Phos-ac, itching 
creeping, moist; Sep., aggravated by scratching; 
Thuj., worse from cold water, better from warm. 

Epididymitis (Orchitis). — Ant-t., nausea ; Arg-n., bruised or con- 
tusive pains; Ars., cramp-like, cutting colic; Aur., 
aching, tensive pains ; Bell., violent lancinations. 
worse P. M.; Brom., induration of left testicle; 
sensation of coldness; Cann., pulling or pressure in 
testicle ; Caps., cramp-like pains in testicles ; Chin., 
tearing pains in left testicle ; Clem., swelling of 
right half of scrotum; pinching pains ; Con., from 
injuries; Cocc, spasmodic drawing pains; Ign., 
peculiar feeling of weakness in pit of stomach ; 
Merc, tearing and shooting pains, shining redness 
of scrotum ; Nit-ac, painful swelling of spermatic 
cord ; Nux., suppressed gonor rhoea, ineffectual 
desire to urinate ; Phos-ac, gnawing pains; Puis., 
suppressed gonorrhoea ; pressive and tensive pains, 
right testicle ; Rhod., testes intensely painful to 
the touch; contusive pain; Spong., chronic draw- 
ing pains ; Staph., drawing, burning stitches in 
right spermatic cord; Sulph., when induration, 
has commenced ; persons with a dirty, greasy 
skin; Thuj., aching pain, aggravated by walking. 

General Inflammation of Penis. — Aeon., with fever, thirst, 
etc.; Bell., with nervousness; Canth., urinary 
troubles; Rhus., erysipelatous redness. 



94 COM PLICA TIONS. 



Hemorrhage. — Aeon., hot, dry skin, thirst; Arg-nit., with pain- 
ful, tensive erections; Canth., with sharp pains in 
back ; Cinnab., scrofulous persons ; Hep., urine 
blood red ; Merc, moist tongue with great thirst ; 
Nit-ac, discharge of bloody slime or pure blood; 
Sep., pain in small of back and region of kidneys ; 
Sil., scrofulous persons, fetid smell of feet ; Tereb., 
bloody urine. 
Hydrocele. — Ars., with tendency to general dropsy ; Aur., melan- 
choly persons ; Calc, young, scrofulous persons ; 
Con., from injury ; Dig., nausea, poor digestion ; 
Dulc, after taking cold; Fluor-ac, suppression of 
stool and urine ; Graph., persons subject to herpetic 
affections; Hell., of children ; coolness of body; puf- 
finess of legs ; Merc, flesh soft and flabby, perspira- 
tion at night ; Phos., in consumptives ; Puis., per- 
sons subject to varicose veins ; blue eyes, light 
hair ; Rhus., left side only affected ; Sil., ill-fed, 
ill-nourished persons ; Spong., young, scrofulous 
persons; Sulph., very large swelling, tense and shining. 
Nymphomania — Agar., selfishness; Ars., restlessness, thirst for 
cold water; Cannab., sterile women; Canth., ag- 
gravated urinary complaints ; Carbo-veg., varicose 
veins in the vulva ; Chin., lying-in-women ; Cim- 
icif, with acute mania; Cocc, chlorotic women; 
Coff., would like to rub the part, but it is too sen- 
sitive, ecstasy; Dig., very slow pulse; Dulc, 
sexual desire increased by a cool change in the 
weather; Hyos., desires to expose her person; 
Lach., worse after sleeping, sadness ; Mosch.^ 
intolerable tickling in the genitals ; Phos., pregnant 
women with spasms; Plat., in virgins, with soft, 
clay-like stools ; Puis., mild, gentle women, with 
blue eyes; Sabin., music is intolerable; Sil., nau- 
sea during an embrace ; Staph., thinks all the 
time about sexual things ; very sensitive to the 
least impression ; Stram., face bloated with blood; 
Thuj., fig warts; Verat., mania, with lewdness; 
Zinc, better during the menstrual flow. 



REPERTORY. 95 






Ophthalmia. — Aeon., after exposure to cold winds; Ailan., cases 
inclined to become chronic; Ant-t., with nausea; 
Arg-nit., children ; Ars., skin rough, dry and dirty- 
looking ; profuse purulent discharge ; Merc, dis- 
charge thin ; frequent relapses ; Nit-ac, copious 
yellow discharge, worse at night; Puis., discharge 
profuse, thick, white or yellow ; mild, gentle per- 
sons ; Sulph., eruptions on the head and face > 
aversion to and aggravation from washing the eyes 
with water ; scrofulous persons. 

Ovaritis. — Aeon., from cold or fright ; Ant-c, with nausea and 
vomiting; Apis, stinging pains; Ars., intense 
burning pains ; Aur., melancholy ; Bell., right 
ovary, pains come suddenly ; Bry., worse from 
motion ; Canth., with dysuria ; Chin., from frequent 
sexual intercourse ; Coloc, colicky pains ; Con., 
labor-like pains ; Hep., when suppuration is feared; 
Ign., with weak, empty feeling in pit of stomach; 
Lye, shooting pain from right to left ovary, worse 
at 4 P. M.; Nux, after drugging, stimulating 
drinks, etc.; Plat., with excessive sexual desire ; 
Rhus, pain, better from motion ; Thuj., left ovary 
worse from walking, riding, and during menses ; 
Zinc, left ovary, better during menses. 

Paraphimosis. — Aeon., accidental; Cannab.; Cinnab., scrofulous 
persons; Coloc, tumefaction of the prepuce ; Con., 
when due to contusions ; Kali-jod., Merc. Nit-ac, 
after abuse of mercury ; Rhus, rheumatic persons ; 
puffy swelling; Sulph., when well indicated rem- 
edies do not act. 

Phimosis. — Cannab., dark redness of prepuce ; Caps., urethra pain- 
ful to touch ; dwindling of testes ; Cannab., penis 
swollen, jerking in the penis; Coloc, tumefaction 
of the prepuce ; Con. and Am., when due to contu- 
sions ; Merc, in syphilitic persons ; Rhus, puffy 
swelling of both prepuce and glans ; worse from 
wet poultices ; Sulph., scrofulous persons, when 
other well-chosen remedies fail. 



96 COMPLICATIONS. 



Prostatitis. — Aeon., high fever ; Apis., incessant desire to urinate ; 
Ars., chronic cases ; debility ; Bell., pain worse on 
right side ; Bry., with constipation ; Cannab., dart- 
ing stitches in posterior part of urethra ; Con., 
urine flows and stops; Cycl., pressing pain as from 
sub-cutaneous ulceration near the anus ; Dig., 
pale urine, but scanty ; motion increases the desire 
to urinate ; Hep., when suppuration threatens ; 
Kali-jod., lancinating and throbbing pains ; Jod., 
testicles diminished in size ; Lye; stitches in neck 
of bladder and anus at the same time; Merc, 
continual desire to urinate, continuing after mictu- 
rition; aching in perinseum ; Phos., tall, slim per- 
sons with chronic constipation ; Puis., great heat 
and pressure in perinaeum ; stools small and of flat 
shape ; Sil., scrofulous, broken down persons ; 
Sulph., pain of a burning character from prostate 
to end of penis ; Spong., chronic enlargement ; 
Thuj., sensation in the rectum as though a bladder 
had formed. 

Retention of Urine. — (See urinary complaints) Aeon., Apis., 
Am., Ars., Bell., Cann., Canth., Carbo., Con., Hell., 
Hyos., Lye, Nux., Puis., Rhus., Sulph., Zinc. 

Stricture Spasmodic or otherwise. — Aeon., with inflammatory 
fever; Agar., Arg-nit., pain in urethra as if swol- 
len and closed ; Bell., sudden lancinating pains ; 
Berb., premature emission of semen : burning in 
left testis, epididymus, spermatic cord; Cann., ob- 
stinate, irresistible urging to urinate ; Camph., 
strangury, acid urine passed drop by drop ; Canth., 
passes but a few bloody drops at a time; Cic, fol- 
lowing inflammations; Clem., urine passes slowly 
and in a thin stream ; Con., urine flows and stops ; 
Dig., pressing and burning in middle of urethra, as 
if too narrow; Jod., violent and continual erec- 
tions; Kali-jod., excessive swelling of the gians 
penis; Merc, with greenish discharge, worse at 
night ; Nit-ac, after abuse of mercury ; Natr-m., 
after abuse of nitrate of silver ; Nux., painful, inef- 



VA RICO CELE— VEGETA TIONS. 97 

Stricture — Spasmodic or otherwise — 

fectual desire to urinate ; Op., constipation, hard, 
black balls; Sil., discharge of thin, watery matter; 
Stram., cadaverous smelling stools ; Sulph., morn- 
ing diarrhoea ; suppressed gonorrhoea ; Thuj., drop- 
ping of urine after micturition ; the stream is fre- 
quently arrested. 

Varicocele. — Aeon., Am. and Con., due to injuries ; Bell., con- 
gestion in head or other parts of the body ; Calc, 
increased sexual desire; Ham., Lye, weakened 
sexual power ; Lach., great depression of spirits, 
livid appearance of veins ; Nux., constipation, gas- 
tric derangements ; Puis., persons of a lymphatic 
temperament; Sep., heavy and tender feeling, 
chronic cases; Sulph., morning diarrhoea, scrofu- 
lous persons. 

Vegetations (Condylomata). — Nit-ac, Staph., Thuj, 



DISEASES OF GENITAL ORGANS. 

NOT NECESSARILY COMPLICATIONS OF GONORRH(E A 



IMPOTENCE. 

(Incapacity for sexual power in men or women. Due to mal- 
formation of copulatory organs ; to spermatorrhoea, varicocele, castra- 
tion, masturbation and nervous influences.) 

Agar. — Entire relaxation of the penis ; every attempt at coition is 
followed by great debility and languor, and sometimes by 
burning-itching of the skin. 
Agnus. — Great deficiency of sexual instinct, the penis being so 
relaxed that nothing excites it ; discharge of prostatic fluid at 
stool ; discharge of mucus from the urethra during sexual 
excitement. 
Baryta. — Numbness of the genitals ; heaviness in small of back 

and loins; cloudy urine with yellow sediment. 
Camph. — Coldness, weakness and atrophied condition of the genital 

organs. 
Canth. — Coldness of the penis and utter absence of erections, the 

result of previous excesses. 
Caps. — Cold and shriveled testicles, scrotum and spermatic cord ; 

drawing pains in the cord. 
Cupr-acet. — Transient erections, with tension in the perinaeum, 

and rheumatic pains in the back and legs. 
Gels. — The result of masturbation ; organs relaxed ; absence of sex- 
ual feeling ; mind depressed ; constipation. 
Ltc. — Penis cold, blue, relaxed ; loss of sexual desire ; exhaustion ; 
result of sexual excesses. In women, pain in back, right 
ovary; leucorrhoea. 
Mosch. — With diabetes, or following a cold. 
Nit- ac. — In syphilitic cases after the abuse of mercury. 
Phos. — From conjugal onanism; weak memory ; emaciation; ten- 
dency to cough ; pulse unsteady and tremulous ; anxiety. 



ONANISM. 



Phos-ac. — Semen is discharged without erection ; feeling of weak- 
ness of the genitals ; debility and apathy. 

Plumb. — Excessive emaciation and great debility ; hectic fever. 

Sulph. — From masturbation ; ejaculation takes place as soon as he 
approaches his wife ; icy coldness and swelling of the parts. 
Women who have lewd dreams, with discharge from the 
vagina. 



ONANISM. 

(Masturbation, self-abuse). 

Ant-c. — Sadness ; gastric derangements ; alternating constipation 
and diarrhoea. 

Calc-carb. — Palpitation of heart; cough; vertigo; headache; 
constipation, with chalky stools ; increased sexual desire at 
night. Women with too early and too profuse menses, acrid 
leucorrhoea, cold, damp feet. 

Carbo-v. — The most innocent food disagrees ; greenish, acrid leu- 
corrhoea ; irritable and ill-tempered. 

Chin. — Weakness ; painless diarrhoea ; aversion to society. 

Cocc. — Sadness ; irascibility ; anxiety ; imaginary fears ; frontal 
headache. 

CrEOS. — Chronic cases, with epistaxis, fetid diarrhoea and coldness 
of the skin. 

Dig. — Pale cloudy urine ; slowness of the pulse. 

Gels. — Pale face with blue rings around the eyes ; mind depressed ; 
loss of flesh. 

Nux. — Foul taste in the mouth in the morning ; flaccidity of the 
penis ; increased sexual desire ; continual pain in testicles ; 
irritable, and wishing to be alone ; when due to high living. 

Phos. — Weak memory ; blotches on the face ; frontal or occipital 
headache ; tendency to cough. 

Plat. — Red urine, becoming turbid and depositing a red sediment. 
Women — excessive sexual desire ; genitals excessively sensi- 
tive to the touch. 

Puls. — Great sexual excitement ; milky leucorrhoea with backache ; 
menses profuse, of a blackish color. 



100 SPERM A TORRHCEA . 

Staph. — Cases of long standing ; imaginary fears ; confused and 
weak memory ; toothache, with caries of the teeth ; deficiency 
of animal heat ; penis relaxed, with dull and continuous pain 
in testicles. 



SPEEMATOEEHCEA 

(Abnormal discharge of semen, occurring oftener than once in 
ten days. Cause, masturbation ; sexual excesses : gonorrhoea ; 
worms). 
Aloes. — Coldness and sweat of genital organs ; scrotum relaxed ; 

sexual desire increased ; tenderness of testicles. 
Camph. — Great nervous excitability with vertigo and throbbing 

pains in the head ; dragging in spermatic cord. 
C arbo-v. — Prostration ; constipation ; flatulence after eating the 

smallest quantity of food. 
Canth. — Inability to retain the urine ; coldness of the penis ; insa- 
tiable desire for sexual intercourse, with discharge of blood 

instead of semen. 
Gaps. — Sleeplessness ; great sensitiveness to open air ; atrophy and 

coldness of the genitals ; morning erections ; shriveling of 

spermatic cord. 
Caust. — Confused memory ; urine contains stringy mucus ; con 

tinued loss of prostatic fluid. 
Cina. — When due to irritation from worms. 
Chin. — Great debility ; painless diarrhoea ; menses increased ; canine 

hunger. 
Collin. — Urine high-colored ; light-colored stools ; bitter taste. 
Con. — Jerking pain in the teeth; teeth seem to be loose when 

chewing ; difficult urination. 
Gels. — Depression of spirits ; tottering gait ; emission of semen 

during stool ; pale face, with blue rings around the eyes. 
Graph. — Emissions involuntary, without erection ; pain in the back 

of the neck. 
Lach. — Emissions followed by sweat. 

JMerc. — Clammy cold sweats at night ; chilliness and great sensi- 
tiveness to cold ; moist tongue with great thirst ; burning in 

the anus during and after stool j drowsiness. 



SPERM A TORRE (E A . 101 






Nux. — Aggravation from liquor ; frequent and ineffectual desire for 
stool ; gastric irritability ; highly seasoned food or liquors 
aggravate the disease. 

Phos. — Anxious and irritable ; easily alarmed ; pains in the chest ; 
memory impaired. 

Phos-ac. — Apathy ; semen is lost on the least provocation ; loss of 
semen during stool ; black streaks before the eyes not removed 
by wiping them. 

Puls. — Aggravated by frequent bathing ; mild, gentle persons pre- 
disposed to catarrh. 

Sars. — Amorous dreams ; bitter taste in the mouth ; pain in back, 
extending down the spermatic cords ; intolerable smell of the 
genitals. 

SlL. — Burning of the feet, with sweat ; perspiration of the scrotum ; 
aching in sacrum ; weakness and heaviness of the arms ; 
melancholy. 

Staph. — Yery sensitive to the least impression ; discontented, low- 
spirited ; emissions seldom awaken him ; shooting pains 
through right testicle. 

Sulph. — Emissions without erections; watery in character and exces- 
sive in amount. 



DISEASES 

OF 

URINARY ORGANS. 



ALBUMINURIA. 106 



ALBUMINURIA. 

(Albumen in the urine. Due to acute and febrile diseases, 
Bright's or organic disease of kidney, leucorrhcealor gleety discharges 
and blood). 
Arsen. — Restlessness ; drinking often and little at a time : pale, 

puffed face. 
Apis. — Thirstlessness ; frequent and copious discharges of urine, or 

dark-colored and scanty urine ; oedematous swelling of the 

face and extremities ; gastric derangements. 
Arg-nit. — Acute or dull pains, extending from the kidneys down 

the ureters to the bladder ; dark, dried-up or bluish coun- 
tenance. 
Aurum. — Melancholy mood, with desire for death ; bloated, shining 

face ; urine like butter-milk ; mucus sediment ; hot, red 

urine, containing sand. 
Bry. — Irritable ; aversion to motion ; faintness when rising from 

bed. 
Canth. — Burning, stinging, tearing pains in the kidneys, extending 

along the ureters into the bladder ; much mucus in the 

urine ; burning in the neck of the bladder. 
Cupr. — Fever in irregular fits ; twitching of the limbs and biting of 

the tongue ; excessive thirst. 
Colch. — (Edematous swelling and coldness of the feet and legs ; 

urine dark and scanty ; gouty subjects. 
Dig. — Slowness of the pulse ; bluish hue of the skin ; alternate 

emission of large and small quantities of colorless urine. 
Dulc. — Aggravation from taking cold, or cold weather ; turbid, foul 

smelling urine ; micturition painful. 
Gels. — During pregnancy ; high fever without thirst ; flushed face ; 

sudden spasmodic pains in the abdomen. 
Lach. — Urine dark, almost black, scanty ; face puffed, yellowish ; 

climacteric period ; patient worse after sleeping. 
Lyc. — Increased secretion of a whitish, turbid, foaming urine ; pain 

in the back previous to urination, with relief as soon as the 

urine begins to flow ; low-spiritedness and great weariness. 
Sulph. — When due to suppressed eruptions or alcoholic drinks ; pains 

of all sorts in the small of the back. 



106 CYSTITIS. 



CYSTITIS. 

(Catarrh or inflammation of the bladder. Due to gonorrhoea, 

taking cold, irritation from calculi and morbid growths, and medicinal 

agents.) 

Acon. — Brought on by exposure to cold, dry winds, and accom- 
panied by high fever, restlessness, thirst and burning urine of 
a reddish color; micturition painful, difficult, and often 
passed drop by drop ; children place their hands on the gen- 
itals and cry out with the pain. 

Arn. — When due to an injury. 

Ars. — Burning pain at commencement of micturition ; distension of 
the bladder ; cloudy urine, containing pus and blood ; intense 
thirst ; anxiety and restlessness, with fear of death. 

Apis. — Urine dark-colored and scanty ; thirstlessness ; bearing down 
feeling in the bladder, with frequent desire to urinate. 

Bell. — If Aeon, has not proved beneficial ; rapid sinking of strength ; 
spasm of neck of bladder ; region of bladder very sensitive to 
touch ; urine hot and fiery-red. 

Carbo-veg. — Chronic cases in old people ; weakness, with coldness, 
chilliness, and palpitation of the heart. 

Caust. — Frequent, difficult and painful urination ; light-colored 
urine with cloudy sediment ; thirst ; urine loaded with lithic 
acid and lithates ; great debility. 

Canth. — Burning tenesmus and violent pains in the bladder ; urine 
dark colored, bloody, and is passed drop by drop, with ex- 
treme pain ; violent fever, with thirst, but drinking increases 
the pain ; flushed face ; often delirium, and even nausea and 
vomiting. 

Cann. — When due to gonorrhoea ; burning during and after mictu- 
rition ; urine red and turbid or white and turbid. 

Caps. — Urine scanty and light-colored ; spasmodic and cutting pains 
in neck of bladder; burning in urethra after urinating. 

Cofe. — Urine dark-brown, fetid, much mucus, some blood, hot and 
very painful on passing ; very nervous and restless ; sleepless ; 
cannot pass urine without catheter. 

Coloc. — Thick, brown, fetid urine ; alternate stitches in the blad- 
der and rectum ; frequent tenesmus ; colicky pains in the 
abdomen. 



CYSTITIS. 107 



Cupr. — After child-birth ; micturition preceded, accompanied and 
followed by forcing pains, similar to those of labor ; cold 
hands and feet ; thirst. 

Dig. — Pressure on the bladder, with a sensation as if it were too 
full, continuing after micturition ; continual desire to urinate, 
only a few drops being passed at each time. 

Dulc. — From taking cold ; constant desire to urinate ; painful mic- 
turition ; urine turbid and white. 

Hell. — Constant desire to urinate, with painfnl emission of small 
quantities of urine, which is turbid and dark, depositing a 
mucous or purulent sediment. Children cry and fret all 
the time. 

Hyos. — Frequent urination with scanty discharge ; urine yellow or 
turbid depositing a grayish white sediment. 

Hep. — Urine blood red or brownish red ; flocculent and covered 
with a greasy pellicle ; pus in the urine. 

Lyc. — Worse from 4 to 8 P. M. ; pain in small of back before urin- 
ation ; turbid, milky urine, depositing a thick Durulent sedi- 
ment ; bloody urine ; foul-smelling urine. 

Lach, — Feeling as of a ball rolling in the bladder, with dull pain ) 
copious discharge of foaming urine ; yellow or copious brown- 
red urine, depositing a brick-dust sediment 

Nit-ac. — Urine smells like that of horses ; urging after micturition, 
with shuddering along the spine. 

Nux. — After suppressed gonorrhoea or allopathic drugging ; painful, 
ineffectual urging to urinate; discharge of urine drop by 
drop, with burning and tearing ; spasmodic retention of 
urine. 

Phos-ac. — Urine like milk : cramp-like constriction of the bladder, 
anguish and uneasiness before micturition ; paleness of face 
thirst ; emaciation. 

Puls. — Tenesmus of bladder, with painful pressure ; after urinating, 
spasmodic pain in neck of bladder, extending to the pelvia 
and thighs; slimy sediment in urine. 

Sarsap. — Chronic cases ; much pain at the close of urination ; dis- 
charge of white, acrid, turbid matter from the urethra ; severe 
tenesmus as in gravel. 

Sep. — Chronic cases ; greasy cuticle on the surface of the turbid 
urine ; fetid urine, depositing a clay-colored sediment ; during 
and after micturition, chilliness and heat in the head. 



108 DIABETES. 



Sulph. — After gonorrhoea ; scrofulous persons ; painful discharge 
of bloody urine ; sediment thick, tough mucus or purulent; 
pain in urethra after micturition. 

Thuja. — After gonorrhoea ; urine clear when voided, but becomes 
cloudy on standing ; red urine, depositing a brick- dust sed- 
iment. 

Uva Ursi. — Mucus discharge mixed with blood. 



DIABETES. 

(Profuse flow of urine. Causation — hereditary, often.) 

Ars. — Drinks often and little at a time ; earthy complexion • 
faintness. 

Arg-nit. — Desire for sweets; debility; pale but strong-smelling 
urine. 

Arg-met. — Urine greatly increased in amount and contains sugar in 
large quantities ; oedematous swelling of feet and scrotum. 

Arn. — Turbid urine, like butter-milk. 

Amm-carb. — Much thirst ; bitter taste in morning ; desire for sugar. 

Baryta-carb. — Frequent and profuse urination every other day ; 
scrofulous persons. 

Canth. — Urinates every few minutes and a large qnantity at a time 
rapid loss of strength. 

Chel. — After drinking wine ; large quantities of sugar in the urine. 

Carbo-veg. — The most innocent food disagrees. 

Caust. — Frequent and urgent desire to urinate in hysterical females. 

Coloc. — The urine when voided is white and turbid, but after stand- 
ing becomes a milk-white, jelly-like mass ; pale urine, with a 
light brown, transparent, flocculent sediment ; renal pains. 

Eup. PURP — Constant urging with copious discharge, attended with 
aching in bladder. 

Helonias. — Urine profuse, clear, light color ; over-sensitiveness to 
air. 

Kali-care. — Violent thirst in evening and at night ; sunken eyes ; 
frequent and violent desire to urinate at night ; urine of a 
pale, green color ; feeling of cold in intestines, as if water 
were dropped upon them ; fetid breath ; irritable, surly state 
of mind. 



DYSURIA. 109 



Kreos. — Drowsiness with frequent yawning; no appetite; sediment 
red or white ; cold feeling in the epigastric region. 

Lyc. — Urine clear like water, or turbid ; excessive thirst, especially 
at night ; obstinate constipation ; low-spiritedness ; loss of 
sexual power. 

Merc. — Scrofulous or syphilitic persons ; flabby tongue ; offensive 
breath ; great thirst ; canine hunger ; constant desire to 
urinate, with cutting pains in left kidney ; faint, sickish pain 
in abdomen ; always feel worse at night. 

Mosch. — With impotence ; insatiable thirst ; constipation ; 
emaciation ; sugar abundant. 

Murex. — Urinesmells like valerian ; discharges blood while urinating. 

Nux. — The most urine is voided at night ; after allopathic drugging, 
or abuse of stimulants. 

Phos. — White urine with brick-dust deposit and variegated cuticle ; 
nervous debility and trembling. 

Phos- AC. — Urine like milk mixed with jelly-like, bloody pieces, with 
pain in kidneys ; passes large quantities of colorless urine at 
night ; nausea and vomiting ; is very indifferent. 

Plumb. — Hectic fever, with dry, hacking cough and great exhaus- 
tion ; excessive emaciation ; great hunger ; constipation, sweet- 
ish belching and vomiting ; copious red or green urine ; anx- 
iety with restlessness. 

Hhtjs. — In rheumatic subjects. 

Terebin. — Dull, languid feeling, relieved by micturition. 

Uran. — Dyspeptic symptoms ; profuse urination at night. 



DYSURIA. 

(Painful urination. This is the first degree of retention of 
urine). Consult also remedies for gonorrhoea and strangury. 
Acon. — After a cold ; high fever ; dry, hot skin ; urine pale, watery, 

or very dark ; plethoric persons. 
Arn. — After mechanical injuries ; feeling of fullness in the bladder ; 

plethoric persons with red face. 
Ars. — Restlessness ; exhaustion ; great thirst ; burning pains in 

bladder and urethra ; urine normal or green, blue or black. 
Canth — Intense pain on urinating ; violent cutting, pressing and 

cramping pains in bladder, extending into the urethra and 

kidneys ; urine is mixed with blood or with pus and blood. 



110 ENURESIS. 



Camph. — After the abuse of cantharis, turpentine or other drugs. 

Con. — The urine flows and stops, and flows and stops at each emis- 
sion ; difficult and painfnl urination. 

Cann. — Painful jerks in the abdomen ; frequent urging to urinate, 
with profuse flow ; very difficult and painful urination. 

Dulc. — From cold ; getting feet wet ; cold drinks. 

Ltc. — During pregnancy ; red sand in the urine. 

Nux. — From suppression of hemorrhoids, abuse of beer or alcoholic 
stimulants ; after allopathic drugging or hot stuffs. 

Op. — When occasioned by fright or chagrin, with constipation. 

Puls. — From menstrual suppression. 

Phos. — Difficult and scanty urination ; tall, slender persons. 

Sulph. — Scrofulous subjects and those with cutaneous eruptions • 
great pain on urination, the urine being mixed with blood. 



ENURESIS. 

(Involuntary discharge of urine, incontinence of urine. Due to 

worms, calculus, struma, hysteria, paralysis, prostatitis and willful 

laziness). 

Acon. — From fright or cold ; hysterical women ; urine pale and 
watery. 

Aloes. — Enlarged prostate ; constant urging for stool ; passing small 
quantities. 

Amm-C. — At night ; pale urine with red sediment. 

Apis. — Great irritation of the parts ; worse at night. 

Arg-nit. — Pale, fetid urine ; drinking coffee aggravates. 

Arn. — Injuries ; paralysis of sphincter ; constant dribbling. 

Aur. — Especially at night ; paralysis of bladder. 

Bell. — Spasmodic action of bladder ; profuse perspiration ; moan- 
ing during sleep. 

Benz-ac. — Urine high-colored, irritating, and smells like that of 
horses. (Nit-ac). 

Calc. — Small, fat children, who sweat easily and catch cold easily. 

Camph. — After irritating drugs (Canth., Tereb., Copaib., etc.). 

Carbo-veg. — With acidity of the stomach. 

Caust. — Children (boys) with black hair and eyes ; always during 
first sleep ; urine loaded with lithic acid and lithates ; great 
debility ; aggravated by coughing, sneezing, etc. 



HEMATURIA. m 



Cham. — With whooping-cough ; straw-colored, watery urine. 
Cina or Santon. — With worm symptoms and canine hunger. 
Dig. — Slow pulse ; palpitation of heart ; vertigo. 
Dulc. — The result of catarrh of bladder, or cold ; copious, turbid, 

foul-smelling urine. 
Ferr. — Only during the day. 
Graph. — Sour-smelling urine ; scanty discharge. 
Hep. — Urine passed slowly and without force ; discharge of mucus; 

from the urethra ; very hasty in his actions. 
Hyos. — Loss of will to urinate ; or frequent scanty urination. 
Kreos. — Wakes at night with urging, but cannot hold the urine 

only during deep sleep ; strong-smelling urine. 
Lyc. — Urine acid; red sand in urine; observing disposition. 
Merc-sol. — Children who perspire easily ; urine hot, acrid, and sour 

smelling. 
Merc-bin. — Cannot hold the water a moment. 
Natr-mur. — Tenesmus ; brick-dust sediment. 
Petr. — Weakness of neck of bladder ; chronic blenorrhcea ; urine 

drops out after urination. 
Puls. — Of little girls ; worse in the fall. 
Rhus. — Worse during rest ; better from continued motion ; dreams 

of walking, running, etc. 
E.UTA. — While walking and at night ; greenish urine. 
Sep. — Always during first sleep ; (Caust.) ; those who practice mas- 
turbation ; talks during sleep. 
SlL. — With worms ; from blows upon the head ; feet smell badly. 
Staph. — Teeth decay early ; fetid perspiration. 
Sulph. — Pale, lean children, who dislike to be washed ; twitches 

during sleep ; obstinate cases. 
Thuj. — Warty growths. 



HEMATURIA. 

(Bloody urine. Due to gonorrhoea, affections of the bladder, 
kidney, ureter and urethra ; abnormal conditions of the blood ; malig- 
nant fevers ; suppression of menses ; and mental emotions.) 
Acon. — Plethoric persons ; after a cold ; high fever. 
Arn. — After straining from lifting, or other injuries. 



112 HEMATURIA. 



Ars. — Characteristic restlessness, thirst and burning pains. 

Calc. — From getting feet wet ; blood discharged in clots ; putrid- 
smelting urine ; greenish urine. 

Camph. — From the abuse of C ith., Tereb., Copaib., and other irri- 
tating drugs. 

Cann. — With painful jerks in abdomen. 

Canth. — Blood continually dropping from the urethra; burning 
pain before, during and after micturition ; urethra painful to 
touch. 

Carbo-veg. — With epistaxis, exhaustion and flatulency. 

Chimaphil., Ham. — Passive hemorrhage. 

Erigeron. — Urine profuse, of strong odor. 

Hep. — Urine blood-red, flocculent and covered with a greasy pel- 
licle. 

Ip. — Profuse with faintness ; nausea ; flow of blood when not urin- 
ating ; great debility. 

Lyc. — Chronic catarrh or gravel ; discharge of bloody coagula. 

Merc. — Painless discharge during sleeD ; or very painful micturition 
with profuse sweat. 

Natr-m. — Cutting pain in the urethra after micturition. 

Nit-ac. — Active hematuria, urging after micturition with shudder- 
ing along the spine ; discharge of blood between the acts of 
micturition. 

Nux. — After coffee, liquors, or allopathic drugging ; suppressed 
hemorrhoids or menses ; constant desire to urinate passing 
but little at a time. 

Phos. — After sexual excesses ; urination difficult and scanty. 

Puls. — Females with discharge of dark-colored clots ; burning and 
spasmodic pains in bladder and urethra. 

Sep. — Burning and cutting in urethra ; pain in small of back and 
region of kidneys ; yellowish face. 

Sulph. — Burning, stinging and spasmodic pains in the urethra; 
puts feet out of bed ; soles burn. 

Tereb. — Burning in region of kidney ; tenesmus of bladder. Urine 
black. 

Zinc. — Vicarious bleeding, in consequence of suppressed menses ; 
involuntary discharge of urine. 



RETENTION OF URINE. 113 



RETENTION" OF URINE. 

(Due to loss of contractility, paralysis of bladder, etc.; pres- 
sure of womb on bladder; tumors; foreign bodies in urethra or 
bladder; injuries; urethritis; strictures; prostatitis ; and malignant 
d seases.) 
Acon. — From cold, particularly in children, with much crying and 

restlessness ; high fever ; stitches in the kidneys. 
Arn. — With feeling of fullness in the bladder ; tenesmus of neck of 

bladder ; injuries. 
Ars. — After childbirth ; severe thirst and anguish. 
Bell. — In pregnant women when due to over distension ; from de- 
lay in urinating ; in scarlet fever. 
Calc. — From getting feet wet. 
Camph. — After abuse of cantharis, turpentine, or other irritating 

drugs ; constant pressure on bladder. 
Cann. — When obstinate; blood discharged drop by drop. 
Canth. — Urine scalds, and is passed drop by drop with extreme 

pain ; drinking increases the pains. 
Carbo-veg. — Old people, with coldness, chilliness, and palpitation 

of the heart. 
Caust. — Paralysis of muscular coat of the bladder; lithic-acid 

gravel. 
Dulc. — From cold ; getting feet wet ; cold drinks. 
Hell. — Cross and irritable children ; will not allow any one to touch 

them ; bladder distended ; atony of bladder. 
Hyos. — In acute or malignant affections ; pregnant or lying-in 

women ; delirium ; much thirst. 
Nux. — Urging to stool ; dribbling of urine. 
Puls. — Heat, redness and soreness of the vesical region; mild 

persons. 
Rhus, — Rheumatic persons after getting wet. 
SlL. — Scrofulous children suffering from worms. 
Sulph. — Painful desire to urinate ; if any urine is passed, it is 

attended with great pain and effort and is mixed with blood. 
Stram. — Bladder distended, but no pain. 



1U STONE— CALCULUS. 



STONE-CALCULUS. 

(Gravel, sand. Predisposing causes : Fevers, dyspepsia, nerv- 
ous exhaustion, injuries, disease of kidneys or bladder, poverty.) 
Aspar. — Gouty diathesis. 
Arg-nit. — Uric acid disappears from the urine ; scanty and rare 

emission of dark yellow urine. 
Bell. — Urine gold-colored, depositing a red sediment ; nocturnal 

pain in bladder ; oxalic calculus. 
Berb. — Pains extending from kidney to bladder, especially left side; 

pains extend to left testicle, which is drawn up. 
Calc. — Scrofulous or chlorotic children. 
Cann. — Urine turbid ; strangury. 
Colch. — Gouty persons ; urine scanty, brown or black; white 

deposit. 
Erig. — Vesical irritation from stone. 
Lyc. — Much red sand in the urine ; chronic affections of the mucous 

membranes. 
Lith-carb. — Our best remedy. Dark, reddish-brown deposit; pain 

in the ureter and spermatic cord into the testicle. 
Nit-ac. — Urging after micturition, with shuddering along the spine 

urine smells like that of horses. 
Nux. — Chronic derangements of the digestive organs. 
Op. — Dark, red urine, with very thick sediment; or drowsiness, with 

full bladder. 
Petr. — Keddish, brown and fetid urine; red sediment; dark, mu- 
cous clouds in urine. 
Phos. — Broken-down constitutions from loss of fluids ; old people. 
Puls. — Urine retained, with redness, heat and soreness in the region 

of the bladder ; urinary tenesmus. 
Sars. — Urine scanty, slimy, flaky, clayey, sandy ; intolerable smell 

of the genitals ; much pain at the end of urination. 
Sediment, bloody — Aeon., Sep. 

bright — Nit-ac. 

brown — Ambr., Crot-t., Dig. 

chalky — Led., Phyt. 
cheesy — Sec-cor. 

clayey — Amm-m., Berb., Phos., Sars., Thuj. 



STRANGURY. 115 



Sediment, dirty-brown — Aeon. 

gray— Kali-j. 

light-brown — Coloc, Puis. 

milky — Ant-t. 

pink — Sep., Lob. 

purple — Ant-t., Bov., Flu-ac. 

red — Ambr., Ars., Bell., Berb., Camph., Carbo-v., Chel., Con., 
Creos., Graph., Lach., Led., Lye., Mezer., Natr-m., 
Nit-ac., Petr., Plat., Puis., Sec-cor., Seneg., Sep., 
Sulph., Verat-vir. 

reddish-brown — Lith-carb. , Nit-ac. 

white — Aeon., Aloe., Alum., Bell., Benz-ac., Berb., Bry., 
Calc., Camph., Canth., Caps., Chin., Colch., Dig., 
Ferr., Graph., Hep., Ign., Nit-ac., Petr., Phos., Phyt.. 
Sec-cor., Sep., Sulph. 

yellow — Aloe., Bary., Kali-i.. Lye, Phos., Sep., Sil., Spong. 



STKANGTTRY. 

(Extreme difficulty in urinating ; urine passed drop by drop, 
with tenesmus of neck of bladder. See also Dysuria). 
Acon. — A few drops are passed with great pain ; urine dark red and 

cloudy. 
Apis. — Dark, scanty urine ; stinging pains. 
Bell. — When due to over-distension ; from delay in urinating. 
Cannab. — Urine bloody ; discharged drop by drop. 
Camph. — From Cantharis poisoning. 
Canth. — Urine dark colored, bloody, turbid ; thirst, but drinking 

increases the pain. 
Caust. — Brought on by taking cold ; burning pain. 
Dig. — Thick blood-red sediment. 
Gels. — Spasmodic cases; great nervous irritation. 
Hyos. — Bladder greatly distended. 
Lyc. — With tympanitic distension of the abdomen ; children during 

dentition. 
Merc. — Perspiration on making the attempt to urinate ; chilliness 

and heat alternating. 



116 SUPPRESSION OF URINE. 

Nux. — Spasmodic cases ; suppression of hemorrhoids ; abuse of beer 
or stimulants ; spasmodic contractions of the urethra ; chronic 
irritation lower part of spine. 

Op. — Sensation as if the passage were closed. 

Phos. — Anxious and irritable ; emaciated ; tall persons with black 
hair and eyes ; sensation as if the passage of urine was im- 
peded. 

Puls. — Due to getting wet ; penis and scrotum drawn up. 

Pareira. — Can only pass urine when on his knees ; strong-smelling 
urine. 

Thuj. — Violent stitches in glans. 



SUPPRESSION OE URINE. 

Ailanth. — With jaundice and constipation. 

Apis. — Pulse almost imperceptible. 

Arn. — After injuries. 

Ars. — With anxiety, restlessness, thirst and rapid prostration. 

Bell. — With violent delirium; jerking of the limbs; face red and 

hot ; constipation ; profuse sweat. 
Bis. — Vomiting, with great prostration ; paralytic weakness and 

weariness in right arm. 
Camph. — Complete after cantharis and turpentine. 
Calc-carb. — Scrofulous children. 
Canth. — In yellow or typhoid fevers; chronic inflammation of 

kidneys. 
Caust. — With paralysis of the limbs, following diphtheria or other 

acute diseases. 
Con. — Unusual severe pain in the kidneys at night ; old men 

and women. 
Cupr. — Alternation of convulsions with talkative delirium ; bluish 

color of the skin. 
Dig. — Scarlet fever with dropsy ; bluish, doughy appearance of the 

swollen parts. 
Hyper. — After injuries of the spine. 
Hyos. — In children suffering from meningitis, scarlet fever, etc.; 

twitching and jerking in all the muscles of the body. 



URGING TO URINATE. 117 

Merc. — Great perspiration at night, but no urine. 

Nit- AC. — After the abuse of mercury ; constipation. 

Nux. — From lead poisoning, 

Petr. — Imagining another person lies in the same bed. 

Phos. — Quick, small, thread-like pulse; cold perspiration of the 

head and extremities ; great emaciation. 
Phyt. — Pulse slow and feeble ; pain in the loins. 
Sec-cor. — Thin, greenish stools ; pulse small, very rapid, contracted 

frequently intermittent. 
Stram. — Talkative delirium ; pulse frequent and irregular. 
Ign. and Mosch. — Hysterical women. 



URGING TO URUsTATE. 

Acon. — Discharge of only a few drops of scalding hot, dark red urine ; 
sometimes excited by merely touching the abdomen ; chil- 
dren place their hands on the genitals and cry out with the 
pain. 

Arn. — After mechanical injuries ; scanty, yellow-red urine. 

Agar. — With copious emission of urine. 

Anac. — With scanty discharge. 

Bell. — With scanty discharge. 

Bry. — With sensation as if the urine passed off spontaneously. 

Creos. — In bed, with contractive pain in the vagina. 

Cann. — With aching pain. 

Canth. — With scanty discharge of dark or bloody urine. 

Careo-an. — Followed by voluptuous tickling in urethra. 

Cham. — With anguish during micturition. 

Chin. — Urging after micturition ; constipation. 

Dig. — At night ; when rising, giddy and drowsy ; passes only a few 
drops at a time. 

Gels. — Scanty discharge, with tenesmus. 

Hell. — With spasms. 

Hyper. — At night, with vertigo in and out of bed. 

Merc. — With scanty discharge of dark red urine, soon becoming 
turbid. 

Nux. — Painful, ineffectual desire, passing but a few drops of red, 
bloody urine. 



118 THE STREAM. 



Nit- AC. — With cutting pain in abdomen. 

Puls. — In mild, gentle women, after getting feet wet, with cutting 

pain during micturition. 
Sep. — With painful bearing down in pelvis. 
Sabad. — Worse after passing a few drops, with drawing in the 

urethra and violent burning. 
Staph. — With the discharge of a little dark yellow urine in a thin 

stream, with continued dribbling after urinating. 
Thuj. — With straining and scanty urine. 
Uva Ursa. — With slight discharge and burning, cutting pain after. 



CONDITIOISr OF THE STREAM. 

Forked. — Arg-n., Cannab., Canth., Petr., Rhus., Thuj. 
Feeble. — Arg-n., Cham., Chin., Creos., Merc, Op., Verat. 
Slow. — Arg-n., Amm-m., Clem., Petr., Plat., Sulph.. Zinc. 
Spreading, Fan-shape. — Cann. 
Thin. — Bell., Camph., Clem., Graph., Merc, Nit-ac. Puis., Sars., 

Staph., Sulph., Thuj., Zinc 
The Stream is interrupted several times before the urine is entirely 

voided. — Con., Chin , Thuj. 



INDEX. 



Abortion 65 

Abrasions , 23 

Abscess 91 

Acne 37 

Adenitis 41 

Albuginitis 59 

Albumen in urine 105 

Albuminuria 105 

Alopecia 40 

treatment of. 40 

American origin of syphilis 10 

Aphonia 44 

Arthritis 75, 92 

Balanitis 23, 73, 92 

Bladder, syphilis of. 59 

in flamm ation of. 73 

Bloody urine , Ill 

Bones, affections of. 54, 57 

Brain, syphilis of 46, 47 

Bronchi, syphilis of. 50 

Buboes 29, 73, 92 

syphilitic 29 

suppurating 30 

creeping 31 

Bullse 35 

Calculus 114 

Caries, syphilitic 56 

Carriers of syphilis 14 

Cartilage, affections of 57 

Chancre , Hunterian 16 

seat 16 

symptoms 16 

follicular 16 



120 INDEX. 



Chancre — indurated 17 

hard 17 

infecting 17 

true 17 

non-indurated 17 

soft 17 

period of incubation 17 

differential diagn osis 18 

relative frequency of hard and soft 19 

how long specific 19 

inflammatory 20 

phagedenic 20, 21 

ulcerative 20 

sloughing 20 

gangrenous 20, 21 

diphtheritic 20, 22 

serpiginous 21 

erosive 21 

diagnosis of. 22 

prognosis 23 

treatment 24 

women 27 

urethra 27 

Chancrelle 17 

Chancroid 17 

Choc-en-retour 64 

Chordee 72, 75, 93 

Condylomata.. 38, 97 

Congenital syphilis , 61 

Cornea, affections of 67 

Corpora cavernosa 59 

spongiosum 59 

Cowperitis 75, 92 

Cystitis 73, 93, 106 

Deafness ■ 50 

Diabetes 108 

Diseased ovum 64 

Dry caries 56 

Dualists, views of IT 



INDEX. 121 

Dysentery 48 

Dysuria 109 

Ear, syphilis of. 50 

Ecthyma-form eruption 37 

Eczema 23, 93 

Enuresis 110 

Epididymitis, syphilitic 59 

gonorrheal 74, 93 

Eruptions, treatment of 39 

Erythema of mucous membrane 43 

Erythematous eruption 34 

treatment 39 

Exostosis 57 

Eye, syphilis of 51 

Fever, syphilitic 33 

Fingers, affections of 53 

Gangenous chancre 20, 21 

General inflammation of penis 93 

Gleet 72, 84 

Gonorrhoea 70 

causes 70 

symptoms 71 

pathology 72 

female 76, 87 

vulva 78 

vagina 78 

uterus 79 

treatment 79 

complications 91 

Gonorrhceal rheumatism 75 

ophthalmia 75 

Gravel 114 

Gummata 53 

Hematuria Ill 

Hereditary syphilis , 61 

parental influence in transmission 61 

diagnosis 66 

prognosis 66 

treatment 68 



122 INDEX. 



Hemorrhage in syphilis 26 

in gonorrhoea 94 

Herpes 23 

Hydrocele 94 

Hyperostosis 56 

Hypertrophy 56 

Impotence 60, 98 

Infantile syphilis 61 

Inflammation, general, ofpenis 73 

Intestines, syphilis of. 48 

Iritis 51 

treatment of. 52 

Joints, affections of... 58 

Keratitis 67 

Kidneys, syphilis of. 58 

Larynx, syphilis of. 49 

Liver, syphilis of. 59 

Lungs, syphilis of. 50 

Masturbation 99 

Maternal infection 63 

Mercury, injurious effects of 54 

Mouth, affections of...., 42 

Mortality in hereditary syphilis 65 

Mucous membranes, affections of 42 

erythema 43 

Mucous patches 44 

treatment of. 45 

Nails, affections of. 53 

Necrosis 56 

Nervous system, affections of...... 46 

Nodes 55 

treatment of * 56 

Nose, syphilis of. 48 

Nymphomania 94 

Onanism 99 

Onychia 53 

Orchitis, gonorrheal ■ 74, 93 

syphilitic 59 

treatment of 60 



INDEX. 123 

Ophthalmia, gonorrhoeal 95 

Osseous system 54 

Ovaries, syphilis of 60 

Ovaritis 95 

Ozaena 48 

Papular eruptions 38 

treatment of 39 

Paraphimosis 28, 95 

treatment 29 

Paternal infection 63 

Pemphigus ... 35 , 67 

Periosteum, affections of 54 

Pharynx, syphilis of. 43 

Phimosis...- 28, 95 

treatment 28 

Phlebitis 74 

Prostatitis 74, 96 

Prostate 59 

Psoriasis 35 

Pustular eruptions 36 

treatment of 39 

Eepertory i 84 

Respiratory organs, affections of. 49 

Retention of urine 74, 96, 113 

Rheumatism, gonorrhoeal 75 

syphilitic 33 

Roseola 38 

Rupia 36,52 

Sarcocele 59 

Scaly eruption 34 

treatment of. 39 

Seminal emissions . . ._. 100 

Skin symptoms 33 

Soft chancre 17 

Spermatic cord, syphilis of. 59 

Spermatorrhoea 100 

Spinal cord, syphilis of. 46 

Spleen, syphilis of. 59 

Stomach, syphilis of 48 



124 INDEX. 

Stone 114 

Stream, the 118 

Strangury 115 

Stricture 76, 96 

Suppression of urine 116 

Swelled testicle 59, 74, 93 

Symptoms of hereditary syphilis 66 

Synovitis 58 

Syphilis, definition of. 9 

etymology of 9 

contagiousness of , 9 

origin of 10 

progress of 10 

way to study 10 

stages of 10 

period of incubation 11, 15 

primary 11, 15 

secondary , 31 

contagiousness of 32 

symptoms of. 33 

tertiary 45 

predisposing causes of 45 

stages defined 11 

never arises spontaneously 12 

nature of poison of. 12 

due to spores ..^. 12 

persons affected by 13 

reason for the exemption of Jews 13 

inoculation of. 13 

methods of communication 14 

tends to exhaust itself 62 

in pregnant women 64 

Syphilitic fever 33 

poison, kinds of. 17 

Teeth in syphilis '. 48, 67 

Testis, inflammation of. 74, 93 

Testicle, syphilis of 59 

The stream 118 

Throat, ulcers of 43 



INDEX. 126 

Tertiary syphilis 45 

predisposing causes 45 

diagnosis 46 

prognosis 46 

of mouth 47 

of throat 47 

of tongue 48 

Transmission of syphilis 65 

Tubercles 53 

treatment of 54 

Tubercular syphilis 37 

Ureter, syphilis of 59 

Urging to urinate 117 

Ulcers of skin 52 

Urinary organs, syphilis of. 58 

Urine, retention of. 74, 96, 113 

suppression of 116 

Vagina, contraction of 78 

Vaginitis 78 

Varicocele 97 

Vegetations 38, 97 

Venereal, definition of 9 

Vesicular eruptions 35 

treatment of 39 

Virus syphilitic 13 

can be destroyed by acids 13 

action of. 14 

Vulvitis 78 

Warts, venereal 38, 97 

White swelling, syphilitic 58 



